Pregabalin as Alternative to Epidural Blood Patch in Treatment of Postdural Puncture Headache: A Randomized Controlled Clinical Trial

Abstract

: Background: Postdural puncture headache (PDPH) commonly arises following a lumbar puncture. It is typically managed through conservative measures or an epidural blood patch (EBP), but each has limitations. This trial aimed to compare the efficacy and safety of pregabalin versus EBP in the management of PDPH. Methods: This randomized controlled trial was conducted on 75 cases with confirmed diagnosis of PDPH. Patients were equally randomized into three groups: Group A (pregabalin group) received oral pregabalin treatment administered at 150 mg daily, with 75 mg given every 12 hours. Group B (EBP group) received EBP and Group C (control group) received conservative treatment. Results: Complete relief of headache was experienced by 13 (52%) patients in group A, 18 (72%) patients in group B, and 5 (20%) patients in group C, with significant distinctions observed among the examined groups (P<0.001). The VAS scores, severity of headache, and frequency of attacks demonstrated a significant improvement at 12h, 24h,36h, and 48h post-treatment within all groups A, B, and C (P<0.001) compared to baseline. Group A was comparable at most time points during follow-up with EBP and better than conservative treatment in terms of VAS scores, severity of headache and frequency of attacks. Conclusions: Pregabalin was comparable at most time points during follow-up with EBP and better than conservative treatment in terms of pain, impact on daily activities and frequency of attacks. Being a non-invasive route, oral pregabalin showed lower back pain than EBP, making it a promising drug for the management of PDPH.