In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one the potential complications of procedures treating the spine- post dural puncture headaches(PDPHA). Listen in as the docs discuss the typical clinical presentation and the management of PDPHA.  

 

PDPHA is defined as a headache that occurs within 5 days of intended or accidental dural compromise. It is caused by leakage of cerebrospinal fluid (CSF), and is usually accompanied by neck stiffness and/or subjective hearing changes. The symptoms usually remit spontaneously within 2 weeks or after autologous epidural blood patch.  

 

The important aspects of the patient history / clinical presentation include but are not limited to:

-history of dural puncture

-postural component of headache (headache improves/resolves with lying flat, and worsens with sitting/standing)

-location of headache is bi-frontal and/or occipital

-onset of headache usually is within first 24-48 hours after dural puncture

 

Treatment of PDPHA depends on the severity / persistence of symptoms, and includes consideration of conservative management with bed rest, Acetaminophen, NSAIDs, caffeine; and the gold standard of treatment for severe or refractory PDPHA is autologous epidural blood patch.

 

Listen as the doctors discuss the definition, differential diagnosis, epidemiology, clinical presentation, pathophysiology (including normal CSF physiology), treatment (including the research behind autologous epidural blood patch), for post dural puncture headache.  

 

This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

References:

1. Candido. Post-dural puncture headache:pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology. 2003.

2. Schievink et al. Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension. JAMA. 2006.

3. Neal JM. Update on postdural puncture headache. Techniques in Regional Anaesthesia and Pain Management 1998; 2: 202–210.

4. Vandam LD & Dripps RD. Long-term follow-up of patients who received 10,098 spinal anesthetics III. Syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). Journal of the American Medical Association 1956; 161: 586–591.

5. Battal et al. Cerebrospinal fluid flow imaging by using phase-contrast MR technique. Br J Radiol. 2011.

6. Abouleish E, Vega S, Blendinger I & Tio TO. Long-term follow-up of epidural blood patch. Anaesthesia and Analgesia 1975; 54: 459–463.