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Postdural puncture headache

from Chief complaints and diagnoses

Published online by Cambridge University Press:  18 December 2009

By
Sohan Parekh  and
Andy Jagoda
Edited by
Stephen H. Thomas
Stephen H. Thomas
Affiliation:
Harvard Medical School
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Summary

This chapter discusses the role of caffeine, Gabapentin, and Epidural blood patch in postdural puncture headache. Postdural puncture headache (PDPH) complicates up to 5% of spinal taps and is also frequently seen postpartum (from anesthesia-related dural puncture). The best treatment for PDPH is prevention. Although a variety of approaches to PDPH have been mentioned in reviews, the drug therapy with the most supporting evidence is caffeine. Oral formulations of caffeine (300 mg per dose) are more effective than placebo for PDPH. Thrice-daily gabapentin is reported in case series to have efficacy in PDPH. The evidence is preliminary, but administration of this anticonvulsant is of potential utility when caffeine fails or is not an option, and patients are not candidates for (or refuse) epidural blood patch. The responsibility of the acute care provider to the patient with PDPH is often administration of temporizing pharmacotherapy pending availability of an epidural blood patch.

Keywords

antidepressantcorticosteroidlocal anestheticsneuropathic painopioidneuropathy
Type
Chapter
Information
Emergency Department Analgesia
An Evidence-Based Guide
 , pp. 351 - 353
Publisher: Cambridge University Press
Print publication year: 2008

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