Causes and manifestations of postdural puncture headache

Authors

  • V. S. Fesenko Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Keywords:

spinal anesthesia, complications, mechanism, presentation

Abstract

Postdural puncture headache is a complication of the spinal dura mater puncture, either accidental during epidural block, or purposeful during spinal anesthesia execution. Leakage of cerebrospinal fluid through the dural hole causes reduced cerebrospinal fluid pressure and may lead to the development of headache hours or days later. Its incidence depends on the patient’s age, gender, body mass index, and probable pregnancy, the needle design, gauge, and orientation. The headache is position-dependent, exacerbated by the upright posture, and relieved by lying down. Other possible symptoms include nausea, vomiting, tinnitus, dizziness, and neck or upper limb pain. Gutsche sign, a significant reduction of the headache severity after manual pressure applied to the right upper abdominal quadrant, is useful but only 73 % sensitive. The differential diagnostics must consider meningitis, intracranial haemorrhage or tumor, cerebral venous thrombosis, cerebral infarction, migraine, and pre-eclampsia.

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References

Юдин С. С. Спинномозговая анэстезия: История, основания, техника и клиническая оценка метода и его применения. – Серпухов, 1925. – 348 c.

Flood P., Li G. A terrible headache in obstetric anesthesia // Ane sthesiology. – 2012. – Vol.116, № 2. – P. 242–243.

Olesen J. et al. The International Classification of Headache Disorders: 2nd edition // Cephalalgia. – 2004. – Vol. 24, Suppl.1. – P. 9–160.

Evans R. W. Complications of lumbar puncture // Neurol. Clin. – 1998. – Vol. 16, № 1. – P. 83–105.

Gaiser R. R. Postdural puncture headache: a headache for the patient and a headache for the anesthesiologist // Curr. Opin. Anaesthesiol. – 2013. – Vol. 26, № 3. – P. 296–303.

Ghaleb A., Khorasani A., Mangar D. Post-dural puncture headache // Int. J. Gen. Med. – 2012. – Vol. 5. – P. 45–51.

Wenk M, Weiss C., Möllmann M., Pöpping D. Procedural complications of spinal anaesthesia in the obesepatient. Anesthesiol. Res. Pract. [Internet]. 2012; Available from: http://dx.doi. org/10.1155/2012/165267

Angle P. J., Kronberg J. E., Thompson D. E. et al. Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation // Anesthesiology. – 2003. – Vol. 99, № 6. – P. 1376–1382.

Amorim J. A., Gomes de Barros M. V., Valença M. M. Post-dural (post-lumbar) puncture headache: Risk factors and clinical features // Cephalalgia. – 2012. – Vol. 32, № 12. – P. 916–923.

Шифман Е. М. Сто лет головной боли. Клиническая физиология постпункционной головной боли: пособие для врачей. – 2-е изд., испр. – М. : МежЭкспертПресс; Петрозаводск : ИнтелТек, 2004. – 64 с.

Weed L. H., McKibben P. S. Experimental alteration of brain bulk // Am. J. Physiol. – 1919. – Vol. 48, № 4. – P. 531–558.

Hatfalvi B. I. Postulated mechanisms for postdural puncture headache and review of laboratory models: clinical experience // Reg. Anesth. – 1995. – Vol. 20, № 4. – P. 329–336.

Суслов В. В., Фесенко У. А., Фесенко В. С. Спинальная анестезия и аналгезия: руководство для врачей. – Харьков : СИМ, 2013. – 544 с.

Dodge H. S., Ekhator N. N., Jefferson-Wilson L. et al. Cigarette smokers have reduced risk for post-dural puncture headache // Pain Physician. – 2013. – Vol. 16, № 1. – P. E25–E30.

Turnbull D. K., Shepherd D. B. Post-dural puncture headache: pathogenesis, prevention and treatment // Br. J. Anaesth. – 2003. – Vol. 91, № 5. – P. 718–729.

Reina M. A., de Leon Casasola O., Lopez A. et al. An in vitro study of dural lesions produced by 25-gauge Quincke and Whitacre needles evaluated by scanning electron microscopy // Reg. Anesth. Pain Med. – 2000. – Vol. 25, № 4. – P. 393–402.

Mansutti I., Bello A., Calderini A. M., Valentinis M. [Post-dural puncture headache: risk factors, associated variables and interventions] Assist. Inferm. Ric. – 2015. – Vol. 34, № 3. – P. 134– 141.

Öztürk I., Sırıt I., Yazıcıoğlu D. A retrospective evaluation of the effect of patient position on postdural puncture headache: is sitting position worse? Anaesth. Pain & Intensive Care. – 2015. – Vol. 19, № 2. – P. 130–134.

Schmittner M. D., Urban N., Janke A. et al. Influence of the pre-operative time in upright sitting position and the needle type on the incidence of post-dural puncture headache (PDPH) in patients receiving a spinal saddle block for anorectal surgery // Int. J. Colorectal Dis. – 2011. – Vol. 26, № 1. – P. 97–102.

van Oosterhout W. P., van der Plas A. A., van Zwet E. W. et al. Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study // Neurology. – 2013. – Vol. 80, № 10. – P. 941–948.

Gutsche B. B. Lumbar epidural analgesia in obstetrics: taps and patches // Reynolds F. (ed.). Epidural and Spinal Blockade in Obstetrics. – London (UK): Balliere Tindall, 1990. – P. 95– 106.

Published

2017-03-01

How to Cite

1.
Fesenko VS. Causes and manifestations of postdural puncture headache. PMJUA [Internet]. 2017 Mar. 1 [cited 2021 Dec. 8];2(1):12-20. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/41