What are the symptoms of postdural puncture headaches (PDPH) and how can they be prevented
Postdural puncture headaches are typically bilateral frontal, occipital, or generalized pressure-like or throbbing headaches, worse when upright, which can be associated with nausea, vomiting, dizziness, tinnitus, neck stiffness, and visual symptoms.
They occur up to 40% of the time following diagnostic lumbar punctures, usually within 6 to 72 hours of the procedure. In 80% of patients the headache lasts less than 5 days but rarely can last for up to 1 year.
Risk factors include female gender, ages 18 to 30, smaller body mass index, prior chronic or recurrent headaches, prior PDPH, use of a Quincke needle, a larger diameter needle, perpendicular orientation of the bevel, and not reinserting the stylet.
Atraumatic needles (such as the 22-gauge Sprotte or Whitache) greatly reduce the frequency of PDPH. Bed rest following lumbar puncture does not reduce the frequency of PDPH.
Bed rest is the initial treatment. Oral caffeine 300 mg every 6 to 8 hours might help temporarily.
Caffeine sodium benzoate 500 mg in 1000 mL normal saline over 1 hour followed by 1000 mL of normal saline over 1 hour may relieve the headache in perhaps 50%.
Persistent headaches can be treated with a lumbar epidural blood patch.
