TDNet Discover

A post-dural puncture headache (PDPH) is a known complication following a dural puncture and most commonly occurs after neuraxial anesthesia or diagnostic lumbar punctures. The incidence of PDPH ranges from 0.3% to 45% with spinal anesthesia and up to 81% of epidural placements in parturients following unintended dural puncture. Increased incidence is seen with larger needle gauges and cutting needle designs. Patients may experience debilitating headaches along with additional symptoms, including neck stiffness, nausea, vomiting, and visual changes, leading to prolonged hospital stays, patient discomfort, and increased costs. Obstetric patients are of concern, as PDPH may impact their ability to care for themselves or their newborn and increase the chances of future complications such as chronic headaches, subdural hematomas, or depression. The incidence and potential side effects of PDPH warrant a review of current literature to offer healthcare providers guidance on managing this known complication. Current literature recommends an epidural blood patch (EBP) as an effective treatment for PDPH; however, this is an invasive treatment option that requires experienced providers, time, and resources, and may lead to additional pain and complications such as infection and neurological deficits. Numerous reviews on the management of PDPH exist, but few exclude invasive treatments and focus solely on conservative treatments. Conservative treatments involve pharmaceutical and minimally invasive procedural interventions, which can improve patient satisfaction and decrease recovery time. Therefore, this literature review aims to evaluate the efficacy of conservative treatment measures for managing PDPH to reduce the likelihood of requiring more invasive treatments, such as an EBP.