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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Post dural puncture headache is one of the major complications of spinal anaesthesia. In order to establish this diagnosis, the headache must be dependent on the position of the patient. The symptoms are probably due to leakage of cerebro-spinal fluid from the subarachnoid space to the epidural space which results in intracranial hypotension and tension of the nociceptive intracranial structures. The incidence is highest in young patients and the complication is observed more frequently in women than in men. In all age groups, the frequency and severity of the condition depend upon the calibre of the puncture needle and, for this reason, the finest possible needle should be employed. The only well proved prophylactic and curative treatment consists of establishing an epidural blood-patch. This procedure should be considered as the primary method of treatment in patients in whom post dural puncture headache contributes to prolongation of the period of convalescence.
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PMID:[Post-dural puncture headache]. 218 50

Among 873 consecutive patients who had undergone a total of 1021 spinal anaesthesias involving puncture of the lumbar dura, 75 (7.35%) complained of Postdural Puncture Headache (PDPH). The severity of each patient's PDPH was categorized, on a scale from mild to severe, on the basis of the onset, duration, severity of the headaches, and the degree to which they were accompanied by auditory and vestibular symptoms. In the patients who developed PDPH, 65% developed symptoms within 24 hours of the lumbar punctures and 92% developed symptoms within 48 hours. For the patients who recovered spontaneously the mean duration of the PDPHs was 5 days, with a range of 1-12 dyas. PDPH was characterized by headaches that were influenced by the patient's posture and the severity of PDPH was categorized as follows: Mild PDPH resulted in a slight restriction of their physical activity. These patients were not confined to bed and had no associated symptoms. Moderate PDPH forced the patient to stay in bed for part of the day, and resulted in restricted physical activity. Associated symptoms were not necessarily present. Severe PDPH. Patients were bedridden for the entire day and made no attempt to raise their head or to stand. Associated symptoms were always present. Forty-five of the PDPH patients (60%) recovered spontaneously. Of these, 8 patients (11%) were categorized as mild cases of PDPH, 14 (19%) as moderate, and 23 (30%) patients as severe cases of PDPH. Thirty of the PDPH patients (40%) were treated with an autologous epidural blood patch (AEBP). Of these, 27 patients (36%) were classified as severe and 3 patients (4%) as moderate PDPH.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. 757 8

Post dural puncture headache is a common sequelae of spinal and, sometimes, epidural anesthesia. Since 1960, the practice of placing autologous blood into the epidural space to treat spinal headache has been used with great success. The blood patch can provide immediate symptom relief from spinal headache and repair of the CSF leak, which is the basic mechanism of post dural puncture headache. Discrepancies exist in the literature and in today's common practice regarding technique and timing for this treatment. This is a procedure not without complications and requires caution. Contained herein are recommendations for safe and effective use of the epidural blood patch. Following these procedures, anesthetists will likely see an 85% to 98% immediate cure rate for post dural puncture headache with the fewest possible complications.
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PMID:The epidural blood patch--current practices and concerns. 788 53

Post dural puncture headache (PDPH) represents a complication of anesthesia (with an increased incidence in obstetric patients) or as the consequence of a diagnostic lumbar puncture. The aim of the present study was to evaluate the efficacy of the epidural blood-patch (EBP) versus the conventional medical treatment of post-anesthetic headaches also including the PDPH following a diagnostic puncture, a category of patients rarely referred to the anesthesia consultation in our hospital because it was believed that they might have equal benefit from conventional measures due to the smaller size of needles used. We studied in a prospective, randomized, double-blinded manner 32 obstetric and non-obstetric patients with PDPH having the onset of the symptoms 24 hours before the inclusion in the study. The patients were randomly divided in two groups: group A (16 patients) receiving conventional treatment (oral and intravenous fluid replacement, non-steroidal anti-inflammatory drugs--NSAIDs--, caffeine) and group B (16 patients) in whom an epidural blood-patch was performed. The intensity of the headache was evaluated using a visual analogue scale (VAS) from 0-10, before, 2 hours and 24 hours after the EBP. There were no statistical differences concerning the demographic data and the cause of PDPH between the groups (p > 0.05). The intensity of PDPH was similar before performing the EBP (p > 0.05), with a value on VAS of 8.2 +/- 1,4. in group A and 8,0 +/- 1.6 in group B. Two hours after the treatment, the intensity of headache on VAS diminished extremely significant (p < 0.0001): in group B the value was 1.0 +/- 0,18 versus 8.2 +/- 1.4 in group A. The difference recorded after 24 hours remained statistically significant (p < 0.0001): the VAS scores were 0.7 +/- 0,16 and 7.8 +/- 1.2 respectively. The epidural blood patch represents the first choice treatment of PDPH no matter the etiology, being significantly superior to the conventional treatment which did not affect pain scores. In severe PDPH there is no reason to delay the EBP more than 24 hours after the diagnosis as all except two patients of the conventional treatment group required blood patching following the study period.
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PMID:Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. 1661 59

Post dural puncture headache can be a debilitating complication of epidural and subarachnoid anaesthesia for a new mother. In a survey of 18,337 epidurals and 5021 subarachnoid blocks performed for obstetric procedures over a 23-year period in a district general hospital maternity unit, there were 167 recognised accidental dural punctures after epidurals (0.91%), with 147 patients (88%) developing post dural puncture headache. In addition there were 52 post dural puncture headaches after subarachnoid blocks (1.04%). Successful management of accidental dural puncture and post dural puncture headache requires adherence to clear policies and protocols, with close follow-up of patients by an experienced obstetric anaesthetist.
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PMID:Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. 1903 14

Post dural puncture headache (PDPH) can be observed after any trauma to the dura. The hallmark of PDPH is an increasing headache when assuming the upright position and improvement with the supine position. Diagnosis of PDPH is essentially based on history of dural puncture and clinical presentation. In most cases, if initial conservative therapies fail to provide the relief of symptoms, an epidural blood patch is the therapy of choice. Epidural blood patch is a safe and effective treatment for PDPH and routinely done for acute onset of postural headache after spinal or epidural anesthesia or analgesia. Here, we report the successful treatment of chronic daily headache with a postural component via an epidural blood patch one year after the onset. We also review the literature pertinent to the use of epidural blood patch in chronic daily headache patients with postural component.
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PMID:Epidural blood patch for chronic daily headache with postural component: a case report and the review of published cases. 1819 72

Spinal anesthesia is major complication is Post-Dural Puncture Headache (PDPH) which is an intense and debilitating event. We decided to assess if intravenous administration of dexamethasone can decrease the incidence and/or intensity of this kind of headache. For this purpose 178 patients, who were supposed to undergo lower extremity orthopedic surgery, were enrolled in the study . Before spinal anesthesia was initiated, the first group (DXM-group) received 2 mL intravenous (i.v) dexamethasone whereas the second group (PCB-group) received 2 mL i.v. normal saline. After termination of surgery, a 7 days follow-up started to observe the possible occurrence and intensity of PDPH. There was no statistically significant difference between DMX and PCB groups regarding the incidence of PDPH. However, the intensity of headache differed between the two groups being less severe if IV dexamethasone had been given prophylactically. Dexamethasone can be used to decrease the severity of PDPH in patients who receive spinal anesthesia.
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PMID:Dexamethasone in preventing post-dural puncture headache: a randomized, double-blind, placebo-controlled trial. 2214 53

Background Post dural puncture headache (PDPH) is an iatrogenic cause of patient morbidity in pain management after spinal or epidural anaesthesia, as well as after diagnostic lumbar puncture. Most patients respond to conservative treatment or to epidural blood patch, yet limited options for effective treatment are available for patients who fail these treatments or present with theoretical contraindication. Case report We present a case of a patient with previously diagnosed human immunodeficiency virus and hepatitis C, who presented with signs of PDPH, which placed him at a theoretical risk of meningeal seeding of the virus during the blood patching procedure. Conclusion We successfully treated the post dural puncture headache and avoided the risk of viral seeding of the meninges by using a fibrin sealant.
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PMID:Treatment of post-dural puncture headache using epidural injection of fibrin sealant as an alternative to autologous epidural blood patch (case report). 2991 93