Postdural puncture cephalgia

Abstract

Since August Bier reported the first case in 1898, postdural puncture cephalgia (PDPC) has been a problem for patients after dural puncture. Bier’s article discussed the pathophysiology of low-pressure headache caused by the leaking of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. Clinical and laboratory research for the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPC than traditional cutting-point needle tips (Quincke-point needle). The taking of a thorough history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPC. In high-risk patients, that is, those younger than 50 years of age, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24 to 48 hours of dural puncture. The optimum volume of blood has been shown to be 12 to 20 mL for adult patients. Complications resulting from autologous epidural blood patch are rare.