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    Post Dural Puncture Headache

    Contributed by:
    SingHealth Duke-NUS Anaesthesiology & Perioperative Sciences Academic Clinical Programme


    Post Dural Puncture Headache: What is it?

    If a patient has received a spinal or epidural injection, there is a 1 in 100 to 1 in 500 chance of getting a headache called a post dural puncture headache (PDPH). Though it is not common, it is a well-known complication of a spinal or epidural injection.

    The brain and spinal cord are surrounded by a bag called the dura containing the cerebrospinal fluid (CSF). When an epidural injection is given, a needle is used to inject painkiller medication just outside the dura. If the needle passes through the dura, a hole is created from which CSF can leak out. Similarly, when a spinal injection is given, a fine needle is intentionally inserted through the dura for it to work. If too much CSF leaks out through the dural hole, the pressure in the bag is reduced, causing the headache.

    Symptoms of Post Dural Puncture Headache

    The headache can develop anytime within one week of the spinal or epidural injection, but is most commonly seen in the first few days. It is usually felt at the front or back of the head, and is typically worse on sitting or standing, and relieved by lying down. There may be other symptoms, such as neck pain, nausea-vomiting or discomfort when looking into bright lights. Some patients often describe it as a very bad migraine, worse when sitting or standing up.

    Treating Post Dural Puncture Headache

    How can the headache be treated?

    • Rest flat in bed, as this will ease the headache
    • Keep hydrated by drinking plenty of water
    • Take painkillers, like paracetamol (Panadol®) and non-steroidal anti-inflammatory drugs like mefenamic acid (Ponstan®), ibuprofen (Brufen®) or diclofenac (Voltaren®)
    • Caffeine tablets or caffeinated beverages e.g. coffee or tea may help
    • Avoid lifting of heavy objects or straining at the toilet as this may make the headache worse. Laxatives may be useful.

    What are the other choices if the headache does not get better?

    This headache will usually get better in a few days. If the headache persists for more than a few days despite the above measures, the patient may be offered an epidural blood patch for relief.

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