Materiały źródłowe

• #1 Solutions for spinal headaches

  https://www.contemporaryobgyn.net/view/spinal-headaches

  The diagnosis and management of headaches in the postpartum patient is a frequently encountered situation for the ob-gyn physician. In fact, 39% of women report having a headache within 1 week after giving birth. […] Because of this and given the nature of labor analgesia via neuraxial block in modern-day peripartum care, it is increasingly important for obstetricians to have a more in-depth understanding of the postdural puncture headache (PDPH). […] A PDPH, also known as a spinal headache, occurs in 6% to 36% of all neuraxial procedures, but only in about 1% of all neuraxial blocks on the labor and delivery floor. […] The headache is caused by a slow cerebrospinal fluid (CSF) leak through a defect in the meninges, causing intracranial hypotension with resultant traction on pain-sensitive structures and reactive venodilatation.

• #1 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  According to the Headache Classification Committee of the International Headache Society, headache after lumbar puncture is defined as bilateral headaches that develop within 7 days after a lumbar puncture and disappears within 14 days. […] The onset of headache after lumbar puncture is usually within 24-48h after dural puncture, but contrary to the above definition, it could be delayed by up to 12 days, indicating that the time points in the definition are random. […] This is essentially a clinical diagnosis and the history of a dural puncture and the postural nature of the headache with associated symptoms usually confirms the diagnosis. […] If a diagnostic lumbar puncture is performed, it may show a low cerebrospinal fluid (CSF) opening pressure, a slightly raised CSF protein and a rise in CSF lymphocyte count.

• #1 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  If you’ve had a spinal tap in the last 14 days, the diagnosis is often obvious. In that case, you usually don’t need tests. […] If you haven’t had a spinal tap, providers typically use magnetic resonance imaging (MRI) to diagnose the source of the headache. […] To manage most spinal headaches, healthcare providers recommend lying down in a flat position. […] If a spinal headache lasts more than a few days, your provider may recommend an epidural blood patch. […] The prognosis (outlook) for a spinal headache is generally good. […] About 85% of all spinal headaches get better without treatment. […] Contact your healthcare provider if you experience a severe headache after a spinal tap, especially if it lasts longer than 24 hours. […] If you experience a severe headache after getting a spinal tap or epidural, tell your healthcare provider.

• #1 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. […] The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. […] However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache. […] This mechanism is consistent with magnetic resonance imaging (MRI) in several reported cases of PDPH.

• #1 Spinal headaches – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spinal-headaches/symptoms-causes/syc-20377913

  Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. […] Most spinal headaches also known as post-dural puncture headaches resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment. […] Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia especially if the headache gets worse when you sit up or stand. […] Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) that surrounds the spinal cord. […] Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia. […] Sometimes epidural anesthesia may lead to a spinal headache as well.

• #1 Spinal headache: Symptoms, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/spinal-headache

  Healthcare professionals do not typically require imaging studies or laboratory tests to help them diagnose this condition. If a persons spinal headache does not go away, doctors may then use imaging tests like CT and MRI scans to rule out other conditions. […] A person may treat spinal headaches with analgesics, hydration, and avoiding being in an upright position. A doctor may treat more serious spinal headaches with an epidural blood patch. […] People should speak with a doctor if they think they may be experiencing a spinal headache and seek immediate medical attention if they experience a sudden or severe headache.

• #1 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Recognizing and diagnosing spinal CSF leak can be challenging, largely due to low familiarity on the part of health care professionals. […] The most important clues to the diagnosis of intracranial hypotension lie in the patient history. […] Misdiagnosis and delayed diagnosis of spinal CSF leak remain common, largely due to low familiarity by health care professionals, as we see with all uncommonly recognized disorders. […] There is considerable variability in clinical presentations and many diagnostic challenges. […] Not surprisingly, many patients suffer for months or years before a correct diagnosis is made. […] Diagnostic testing includes lumbar puncture (not required), cranial (brain) imaging, spinal imaging, and occasionally a nuclear medicine study called a radioisotope cisternogram.

• #1 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Cranial imaging includes both MRI and CT. An MRI of the brain should be done in ALL cases where a spinal CSF leak is suspected. […] Spinal imaging is performed to localize leaks. […] It should be emphasized that spinal imaging may not be necessary since many patients respond well to lumbar epidural blood patching. […] An LP may be done to measure the opening pressure and to collect CSF for analysis, but this is not required to make the diagnosis. […] There are five findings typically seen on imaging that can be remembered by the mnemonic SEEPS when considering the diagnosis of spinal CSF leak. […] The following are some of the established criteria for diagnosis of spinal CSF leak. […] Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure of spontaneous origin. […] In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).

• #1 Let’s make misdiagnosis the exception – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/lets-make-misdiagnosis-the-exception/

  In recent years, the awareness of spontaneous intracranial hypotension (SIH) has increased such that more patients are being diagnosed correctly. But sadly, misdiagnosis remains the rule rather than the exception. […] Because SIH has an identifiable underlying cause, a spinal cerebrospinal (CSF) leak, it is often treatable with the guidance of specialized diagnostic testing as needed. […] The estimated incidence is based on a single urban emergency department study roughly estimating the annual incidence at 5 per 100,000. […] More accurate estimates are needed. […] We do know that SIH isn’t nearly as common as most other causes of headache, which contributes to low awareness, misdiagnosis, and delayed diagnosis. […] Migraine is the most common misdiagnosis among patients with SIH. An important hallmark of SIH is that migraine treatments are almost entirely ineffective.

• #1 Statement on Post-Dural Puncture Headache Management | American Society of Anesthesiologists (ASA)

  https://www.asahq.org/standards-and-practice-parameters/statement-on-post-dural-puncture-headache-management

  PDPH Diagnosis The diagnosis of PDPH is based on both the clinical presentation (documented dural puncture and severe postural headache being most characteristic) and a detailed history and physical examination. The differential diagnosis of PDPH in an obstetric patient includes caffeine withdrawal, migraines, meningitis, sinus related, preeclampsia, pneumocephalus and intracranial pathology such as an intracranial subdural hematoma and posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome should be considered in patients presenting with headache, elevated blood pressure and proteinuria as this syndrome is seen in preeclamptic patients. A patient presenting with severe unexpected, atypical PDPH features, needs full neurological evaluation including a neurology consult and radiological imaging (e.g., CT Scan, MRI).

• #1 Postdural Puncture Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430925/

  Postdural puncture headache (PDPH) is a potential complication associated with a lumbar puncture characterized by a bilateral frontal or occipital headache that is worse when the patient is in an upright position, nausea, neck pain, dizziness, visual changes, tinnitus, hearing loss, or radicular symptoms in the arms. […] Diagnosis is primarily clinical, with imaging reserved for atypical or persistent cases. Management approaches comprise conservative measures initially, including hydration, caffeine, and analgesics, and invasive interventions, such as EBP, for more severe symptoms. […] The diagnosis of PDPH is made on clinical examination, and laboratory or imaging studies are usually unnecessary. However, in patients with severe and persistent symptoms, particularly those where positional changes of the patient have no effect, neuroimaging is indicated.

• #1 Solutions for spinal headaches

  https://www.contemporaryobgyn.net/view/spinal-headaches

  Several patient factors can increase the risk of a PDPH, including female gender, pregnancy, lower body mass index, and a history of headaches. […] The type and size of needle used for dural puncture also influences the prevalence of PDPH, with Tuohy needles and cutting/traumatic spinal needles being more likely to cause a PDPH than nontraumatic/pencil point spinal needles. […] Patients with PDPH will most often present with a dull or throbbing headache that is bilateral, occipital-frontal in location, and of varying severity. […] The true hallmark of this condition is a change in the severity of the headache with patient positioning. […] Patients who present with mild PDPH without associated symptoms can often be treated conservatively without the need for intervention by an anesthesiologist.

• #1 Let’s make misdiagnosis the exception – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/lets-make-misdiagnosis-the-exception/

  Another common misdiagnosis is new daily persistent headache (NDPH). […] NDPH is usually treated with medications, which, like treatments for migraine, are almost entirely ineffective for SIH. […] Cervicogenic headache can also be worse with upright posture, similar to SIH. […] A CT of the head may show some evidence of SIH but is often negative. Brain MRI with gadolinium enhancement is the standard-of-care initial diagnostic imaging for ALL patients suspected of having SIH. […] Despite increasing awareness, misdiagnosis remains the rule rather than the exception when it comes to SIH. […] For experienced radiologists, neurosurgeons, and neurologists, SIH and Chiari I are easily distinguished. […] It is important that treatment of the underlying spinal CSF leak is not overlooked.

• #1 Postdural Puncture Headache – NYSORA

  https://www.nysora.com/topics/complications/postdural-puncture-headache/

  Postdural puncture headache (PDPH) is a well-known complication following interventions that disrupt meningeal integrity. […] The PDPH is characterized by its typical onset, presentation, and associated symptoms. […] Most cases of PDPH will have a history of known or possible meningeal puncture, delayed onset of symptoms (but within 48 hours), and bilateral postural headache. […] Importantly, most non-MPHs will not have a strong positional nature. […] Diagnosis of PDPH can be particularly challenging in patients who have undergone lumbar puncture as part of a diagnostic workup for headache. […] A careful history with a brief consideration of other possible diagnoses is usually all that is necessary to differentiate PDPH from other causes of headache. […] Physical examination plays a limited role in the diagnosis of PDPH. […] Laboratory studies are usually not necessary for the diagnosis of PDPH and, if obtained, are generally unremarkable.

• #1 Spinal Headache

  https://mobile.fpnotebook.com/Neuro/Headache/SpnlHdch.htm

  Occurs in 10 to 30% of patients after Lumbar Puncture (less common with smaller gauge, blunt needles) […] Diagnosis: Orthostatic Headache with CSF Leak or procedure […] Lumbar Puncture with opening pressure of 6 cm H2O […] No other pathologic cause.

• #1 Postdural Puncture Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430925/

  Lumbar puncture in patients suspected of having PDPH is discouraged because a second dural puncture site may actually worsen the symptoms. […] In those patients with long-standing PDPH or intracranial hypotension, an MRI with intravenous gadolinium administration may demonstrate descent of the cerebellar tonsils below the foramen magnum, effacement of the basilar cisterns, thickening of the meninges, subdural fluid accumulation, venous sinus engorgement, and an enlarged pituitary gland. […] The initial management of PDPH symptoms involves administering analgesics, oral or intravenous hydration, and avoiding having the patient in the upright position. […] Definitive treatment by administering an epidural blood patch is usually recommended when symptoms persist after conservative treatment has failed. […] The prognosis for PDPH is generally excellent, with the majority of cases resolving with bed rest, analgesics, and hydration. […] The most crucial consideration in preventing PDPH is using a small-gauge, pencil-tipped, noncutting spinal needle.

• #1 Spinal Headaches: Symptoms, Causes, Treatment | Qwark

  https://qwarkhealth.com/conditions/spinal-headaches

  Spinal headaches are typically diagnosed through physical examination and medical history, as well as a few specific tests. One such test is the „tilt table” test, where the patient lies flat on a table and is slowly raised to an upright position, while monitoring symptoms. Another test is the „blood patch” test, which involves injecting a small amount of the patient`s own blood into the area where the spinal tap was performed. If symptoms improve, it is likely a spinal headache. […] A spinal tap is often necessary to diagnose a spinal headache, as it is the procedure that can lead to one. However, the presence of symptoms, such as headaches that occur when sitting or standing, can often be enough to make a diagnosis without a spinal tap. […] MRI and CT scans may be used in diagnosing spinal headaches to rule out other potential causes, such as a brain or spinal cord tumor. These scans can identify changes in the brain or spinal cord that could be contributing to the headaches.

• #1

  https://www.parkwayshenton.com.sg/conditions-diseases/spinal-headache/diagnosis-treatment

  Diagnosis of a spinal headache typically involves: […] Medical history and symptom review with your healthcare provider […] Physical examination, including assessing the headaches characteristics and related symptoms […] Response to positioning, for example, noting whether the headache improves when lying down and worsens when upright, which is characteristic of a spinal headache […] Imaging studies, such as MRI or CT scan may be used to rule out other causes of headache or confirm the presence of a cerebrospinal fluid leak.

• #1 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  Headache after lumbar puncture is a common occurrence (32%) and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilise the patient. […] If untreated, it can result in serious complications such as subdural haematoma and seizures, which could be fatal. […] It is therefore important that the doctors are aware of the methods available for reducing the incidence of headaches after lumbar puncture. […] This article reviews the scientific literature and highlights the practical issues involved in the diagnosis and management of headaches after lumbar puncture, including the epidural blood patch treatment. […] Headache after lumbar puncture occurs more often in young adults, especially in the 18-30 year age group. […] Young women with a lower body mass index and those who are pregnant have the highest risk of developing headaches after lumbar puncture.

• #1 Confronting Postdural Puncture Headache in Clinical Practice – Neurology Advisor

  https://www.neurologyadvisor.com/features/confronting-postdural-puncture-headache-in-clinical-practice/

  Postdural puncture headache (PDPH) is a known consequence of lumbar puncture used for the diagnosis of neurological disorders, as well as during epidural anesthesia. The International Classification of Headache Disorders published in 2004 defined PDPH as a positional headache occurring within 7 days of postdural puncture (PDP) that worsens with standing and is relieved on lying down. […] PDPH is a commonly encountered complication of procedures that can result in dural puncture, whether in the setting of diagnostic procedures or as a complication of spinal or epidural anesthesia. The frequency of PDPH varies largely based on both patient and procedure characteristics. PDPH is more common in young, thin women; in patients with a prior history of PDPH; and in patients with a history of a chronic headache disorder.

• #1 Spinal headache: A headache that occurs after spinal anesthesia, due to leakage of cerebrospinal fluid.

  https://www.laparoscopyhospital.com/worldlaparoscopyhospital/index.php?pid=649&p=4

  Spinal headache: A headache that occurs after spinal anesthesia, due to leakage of cerebrospinal fluid. […] A spinal headache, also known as a post-dural puncture headache (PDPH), is a type of headache that occurs after a spinal tap or spinal anesthesia. It is caused by a leakage of cerebrospinal fluid (CSF) through the puncture site in the spinal canal. […] Diagnosing a spinal headache typically involves a physical examination and a review of the individual’s medical history. The doctor may also order imaging tests such as a CT scan or MRI to rule out other causes of the headache. In some cases, a procedure known as a „blood patch” may be performed to confirm the diagnosis. […] Spinal headaches result from a decrease in CSF pressure caused by fluid leakage during procedures involving needle insertion into the spinal canal. Risk factors include pregnancy, a history of migraines, and connective tissue disorders. Needle size and technique also play a role in the likelihood of developing this condition.

• #1 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  The exact pathophysiology of headache after lumbar puncture is unclear. […] However, it is most probably related to the hole in the left dura after the needle has been withdrawn, resulting in persistent leak of CSF from the subarachnoid space. […] The following factors contribute to the development of headache after lumbar puncture: Needle size, Direction of bevel, Needle design, Replacement of the stylet, Number of lumbar puncture attempts. […] As headache after lumbar puncture is relatively common and is a significant cause of morbidity, it should always be explicitly discussed when a patient consents for lumbar puncture, especially those who are in a high-risk category, such as young women with a low body mass index, and during pregnancy. […] If a patient develops headache after lumbar puncture with characteristic features, they should be encouraged to lie in a comfortable position, which is mostly in the supine position owing to the postural nature of the symptoms.

• #1 Post Lumbar Puncture Headaches – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/post-lumbar-puncture-headaches/

  Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. […] In terms of the prevention and treatment of post-LP headaches, both are equally important in management. […] Size of the dural puncture site is directly proportional to the likelihood of headache development. […] Conclusion: Parallel direction of needle bevel does decrease incidence of post LP headache. […] Conclusion: Replacement of stylet before spinal needle withdrawal, decreases incidence of post LP headache. […] Conclusion: There is no difference in post LP headache incidence with early ambulation vs bed rest after LP. […] Conclusion: Volume of CSF was not a risk factor for post LP headache.

• #1 Post-dural-puncture headache – Wikipedia

  https://en.wikipedia.org/wiki/Post-dural-puncture_headache

  Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). […] PDPH is a common side effect of lumbar puncture and spinal anesthesia. […] Onset occurs within two days in 66% of cases and three days in 90%. […] Although in very rare cases the headache may present immediately after a puncture, this is almost always due to another cause such as increased intracranial pressure and requires immediate attention. […] Using a pencil point rather than a cutting spinal needle decreases the risk. […] The size of the pencil point needle does not appear to make a difference, while smaller cutting needles have a low risk compared to larger ones. […] However, the evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache is moderate-quality and further research should be done. […] Evidence does not support the use of bed rest or intravenous fluids to prevent PDPH. […] PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia.

• #1

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/spinal-headaches

  Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. […] Most spinal headaches also known as post-dural puncture headaches resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment. […] Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia especially if the headache gets worse when you sit up or stand. […] The provider will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures particularly a spinal tap or spinal anesthesia. […] Sometimes the provider will recommend magnetic resonance imaging (MRI) to rule out other causes of your headache. […] Treatment for spinal headaches begins conservatively. Your provider may recommend getting bed rest, drinking plenty of fluids, consuming caffeine and taking oral pain relievers. […] If your headache hasn’t improved within 24 hours, your provider might suggest an epidural blood patch.

• #1 Statement on Post-Dural Puncture Headache Management | American Society of Anesthesiologists (ASA)

  https://www.asahq.org/standards-and-practice-parameters/statement-on-post-dural-puncture-headache-management

  If a PDPH is suspected, a member of the anesthesia team should see the patient within 24 hours. The intensity of maternal symptoms may dictate the need for an Epidural Blood Patch (EBP). When PDPH is less severe, which may reflect a smaller dural tear with less CSF leak, conservative therapy may be preferred in the expectation the headache resolves without the need for an EBP. If headache is more significant such that activities of daily life and caring for the baby are compromised, an EBP should be considered. […] All patients with a confirmed or suspected UDP or PDPH need a brief physical exam for the presence or absence of neurologic symptoms (e.g., cranial nerve function, motor reflexes). Patient follow-up should occur within 24-48 hours after an UDP. In the first 24-48 hours, conservative measures for symptomatic relief (e.g., non-opioid analgesics, opioids for severe breakthrough pain, lying flat, adequate hydration) are recommended initially before initiating a TEBP. If the PDPH is severe enough or affects the mother-child interaction, a TEBP should not be delayed.

• #1 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  30% of mothers report headaches after childbirth, but only 4.7% of headaches may be attributed to PSH. […] History, symptoms and physical examination help to differentiate PSH from other causes of headache in the postpartum period. […] Diagnostic Lumbar Puncture (LP) should be avoided, as there is a risk of worsening the headache secondary to an additional dual puncture. […] MRI-brain imaging may be considered when the patient has a non-orthostatic headache or develops after an initial orthostatic headache and also when the onset of the headache is more than 5 days after the suspected dural puncture. […] PSH is generally self-limited and benign. Headache usually resolves within a few days, but the longest reported headache after lumbar puncture lasted for 19 months. […] The patient with inadvertent dural puncture may have chronic headache, backache, neck ache, depression, cranial nerve palsy, subdural hematoma or cerebral venous thrombosis. […] All patients with PSH must be referred to an anesthesiologist within 24 hours of its onset and should be followed till resolution of PSH. […] Current approaches to the diagnosis, treatment and management of PDPH are not uniform in India.

• #1 Post-dural puncture headache | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/post-dural-puncture-headache?lang=us

  Post-dural puncture headache, previously known as post-lumbar puncture headache, is a common complication after lumbar puncture (LP), which is often performed for cerebrospinal fluid (CSF) sampling, spinal anesthesia, myelography, etc. […] Diagnostic criteria (c.2018) per the International Classification of Headache Disorders, 3rd edition (ICHD-3) from the International Headache Society are: headache attributed to low CSF pressure (i.e. opening pressure 60 mm CSF) and/or evidence of CSF leakage on imaging; dural puncture has been performed; headache has developed within five days of the dural puncture; not better accounted for by another ICHD-3 diagnosis.

• #1 Post-Dural Puncture Headache – Core EM

  https://coreem.net/core/post-dural-puncture-headache/

  The International Headache Society (IHS) criteria for diagnosis of a post-dural puncture headache (PDPH) requires that the headache meet all four of the following criteria (IHS 2004): […] As many as a 33% of patients with PDPH do not meet these criteria due to: […] Criteria 4 requires resolution of the headache before definitive diagnosis making it impossible to apply these criteria in the ED […] Suspicion for PDPH after an LP should be high even in absence of all of the qualifying diagnostic criteria, especially in higher risk patients, which include women, pregnant patients and young adults (Amorin 2012) […] Post dural-puncture headache affects up to 30% of patients after lumbar puncture. […] Suspect PDPH in all patients who recently underwent an LP or epidural anesthesia regardless of whether they meet the IHS criteria.

• #1 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  Generally, 85% of headaches after lumbar puncture will resolve without any specific treatment. […] However, if conservative measures fail to resolve headaches after lumbar puncture, then specific treatment is indicated 72h after the onset of pain, as it would avert the catastrophic complications of subdural haematoma and seizures that could be fatal. […] The aim of specific management of headache after lumbar puncture is to replace the lost CSF, seal the puncture site and control the cerebral vasodilatation. […] The concept of the epidural blood patch was developed after the observation made on patients who had bloody tap, in whom the incidence of headache was low. […] The presence of fever, local infection in the back and bleeding disorders are the main contraindications for this procedure. […] This procedure has a success rate of about 70-98% and can be repeated if it fails to resolve the symptoms at the first attempt.

• #1 Solutions for spinal headaches

  https://www.contemporaryobgyn.net/view/spinal-headaches

  In the event of failed conservative management or severe symptoms with associated sequelae, an anesthesiologist can be consulted to perform a regional nerve block or an EBP. […] The EBP is an aseptic collection and injection of autologous blood into the epidural space. […] Patients with successful blood patches will have immediate symptomatic relief during the procedure, with cessation of the headache being one of the positive endpoints.

• #1 High and Low Pressure Headache: Symptoms, Causes, and Emergency Signs

  https://headacheaustralia.org.au/high-and-low-pressure-headache/

  A swollen disc indicates that the pressure inside the brain is higher than it should be. […] In terms of causes for high-pressure headaches, there can be too much CSF, which is called hydrocephalus. […] This situation is often solved by surgeons inserting a small drain into the ventricle. […] IIH often presents with headache and visual changes due to the high pressure. […] It can also result in pulsatile ringing in the ears. […] Problems involving the brain such as a tumour, stroke, bleed or inflammation can also take up space and cause headache and symptoms associated with high pressure.

• #1 Let’s make misdiagnosis the exception – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/lets-make-misdiagnosis-the-exception/

  A lumbar puncture may be performed as part of initial testing. […] The headache in SIH is most often located in the occipital region, or back of the head. […] Because SIH patients may also experience pain in the distribution of the trigeminal nerve, trigeminal neuralgia may be diagnosed without the recognition of the underlying cause of the pain. […] There remains a need to elevate awareness among all clinicians. […] So for Rare Disease Day on February 28 and every day, let’s elevate awareness of SIH, so that more patients can receive the correct diagnosis more quickly, then access appropriate testing and treatment of the underlying cause, spinal CSF leak, for better long-term outcomes.

• #2 Types of Headaches: Symptoms, Causes, Treatments, and More

  https://www.healthline.com/health/headache/types-of-headaches

  A spinal headache results from low cerebrospinal fluid pressure following a lumbar puncture. For this reason, it’s also known as a post-dural puncture headache. You might feel this headache in your: forehead, temples, upper neck, back of the head. […] Research estimates that spinal headaches follow a lumbar puncture between 10 and 40% of the time. Onset usually begins within 2 to 3 days but could start several months later. It can also occur following an epidural or spontaneously. This headache typically worsens when you are upright and improves when you lie down. Other symptoms of spinal headache include: nausea, neck pain, dizziness, visual changes, tinnitus or ringing in the ears, hearing loss, radiating pain in the arms. […] Initial treatment for spinal headaches usually includes pain relievers and hydration. It also helps to avoid being in an upright position. Symptoms typically go away on their own after a week or two. In some cases, an epidural blood patch might be used. This is a procedure in which a small amount of blood is taken from your body and injected back into your epidural space. It can help stop cerebrospinal fluid from leaking, stopping the headaches.

• #2

  https://continentalhospitals.com/diseases/spinal-headaches/

  Spinal headaches, also known as post-dural puncture headaches (PDPH), are a specific type of headache that can occur after certain medical procedures involving the spinal cord. […] The primary cause of spinal headaches is leakage of cerebrospinal fluid (CSF) through a small hole or tear in the outer membrane surrounding the spinal cord. […] If symptoms persist or worsen, medical intervention may be necessary. […] One common diagnostic tool used for spinal headaches is a thorough medical history assessment. […] In addition to a comprehensive medical history, physical examinations play a vital role in diagnosing spinal headaches. […] Imaging studies like magnetic resonance imaging (MRI) or computed tomography (CT) scans may be ordered to visualize the structures within the spine and identify any abnormalities that could be causing or contributing to spinal headaches.

• #2

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/spinal-headaches

  Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. […] Most spinal headaches also known as post-dural puncture headaches resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment. […] Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia especially if the headache gets worse when you sit up or stand. […] The provider will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures particularly a spinal tap or spinal anesthesia. […] Sometimes the provider will recommend magnetic resonance imaging (MRI) to rule out other causes of your headache. […] Treatment for spinal headaches begins conservatively. Your provider may recommend getting bed rest, drinking plenty of fluids, consuming caffeine and taking oral pain relievers. […] If your headache hasn’t improved within 24 hours, your provider might suggest an epidural blood patch.

• #2 Postdural Puncture Headache – NYSORA

  https://www.nysora.com/topics/complications/postdural-puncture-headache/

  Postdural puncture headache (PDPH) is a well-known complication following interventions that disrupt meningeal integrity. […] The PDPH is characterized by its typical onset, presentation, and associated symptoms. […] Most cases of PDPH will have a history of known or possible meningeal puncture, delayed onset of symptoms (but within 48 hours), and bilateral postural headache. […] Importantly, most non-MPHs will not have a strong positional nature. […] Diagnosis of PDPH can be particularly challenging in patients who have undergone lumbar puncture as part of a diagnostic workup for headache. […] A careful history with a brief consideration of other possible diagnoses is usually all that is necessary to differentiate PDPH from other causes of headache. […] Physical examination plays a limited role in the diagnosis of PDPH. […] Laboratory studies are usually not necessary for the diagnosis of PDPH and, if obtained, are generally unremarkable.

• #2 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  According to the Headache Classification Committee of the International Headache Society, headache after lumbar puncture is defined as bilateral headaches that develop within 7 days after a lumbar puncture and disappears within 14 days. […] The onset of headache after lumbar puncture is usually within 24-48h after dural puncture, but contrary to the above definition, it could be delayed by up to 12 days, indicating that the time points in the definition are random. […] This is essentially a clinical diagnosis and the history of a dural puncture and the postural nature of the headache with associated symptoms usually confirms the diagnosis. […] If a diagnostic lumbar puncture is performed, it may show a low cerebrospinal fluid (CSF) opening pressure, a slightly raised CSF protein and a rise in CSF lymphocyte count.

• #2 Postdural Puncture Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430925/

  Postdural puncture headache (PDPH) is a potential complication associated with a lumbar puncture characterized by a bilateral frontal or occipital headache that is worse when the patient is in an upright position, nausea, neck pain, dizziness, visual changes, tinnitus, hearing loss, or radicular symptoms in the arms. […] Diagnosis is primarily clinical, with imaging reserved for atypical or persistent cases. Management approaches comprise conservative measures initially, including hydration, caffeine, and analgesics, and invasive interventions, such as EBP, for more severe symptoms. […] The diagnosis of PDPH is made on clinical examination, and laboratory or imaging studies are usually unnecessary. However, in patients with severe and persistent symptoms, particularly those where positional changes of the patient have no effect, neuroimaging is indicated.

• #2 Low-Pressure Headache – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/headaches/low-pressure-headache

  A low-pressure headache occurs in up to a third of people who have had a spinal tap, usually hours to 1 or 2 days afterward. […] Doctors base the diagnosis of low-pressure headaches on the symptoms and the situation. […] If people have had a spinal tap, the diagnosis is usually obvious, and testing is rarely needed. […] If people have not had a spinal tap, imaging tests of the brain, such as magnetic resonance imaging (MRI), may be done.

• #2

  https://www.parkwayshenton.com.sg/conditions-diseases/spinal-headache/diagnosis-treatment

  Diagnosis of a spinal headache typically involves: […] Medical history and symptom review with your healthcare provider […] Physical examination, including assessing the headaches characteristics and related symptoms […] Response to positioning, for example, noting whether the headache improves when lying down and worsens when upright, which is characteristic of a spinal headache […] Imaging studies, such as MRI or CT scan may be used to rule out other causes of headache or confirm the presence of a cerebrospinal fluid leak.

• #2 Postdural Puncture Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430925/

  Lumbar puncture in patients suspected of having PDPH is discouraged because a second dural puncture site may actually worsen the symptoms. […] In those patients with long-standing PDPH or intracranial hypotension, an MRI with intravenous gadolinium administration may demonstrate descent of the cerebellar tonsils below the foramen magnum, effacement of the basilar cisterns, thickening of the meninges, subdural fluid accumulation, venous sinus engorgement, and an enlarged pituitary gland. […] The initial management of PDPH symptoms involves administering analgesics, oral or intravenous hydration, and avoiding having the patient in the upright position. […] Definitive treatment by administering an epidural blood patch is usually recommended when symptoms persist after conservative treatment has failed. […] The prognosis for PDPH is generally excellent, with the majority of cases resolving with bed rest, analgesics, and hydration. […] The most crucial consideration in preventing PDPH is using a small-gauge, pencil-tipped, noncutting spinal needle.

• #2 Statement on Post-Dural Puncture Headache Management | American Society of Anesthesiologists (ASA)

  https://www.asahq.org/standards-and-practice-parameters/statement-on-post-dural-puncture-headache-management

  PDPH Diagnosis The diagnosis of PDPH is based on both the clinical presentation (documented dural puncture and severe postural headache being most characteristic) and a detailed history and physical examination. The differential diagnosis of PDPH in an obstetric patient includes caffeine withdrawal, migraines, meningitis, sinus related, preeclampsia, pneumocephalus and intracranial pathology such as an intracranial subdural hematoma and posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome should be considered in patients presenting with headache, elevated blood pressure and proteinuria as this syndrome is seen in preeclamptic patients. A patient presenting with severe unexpected, atypical PDPH features, needs full neurological evaluation including a neurology consult and radiological imaging (e.g., CT Scan, MRI).

• #2 Evaluation of Cervicalgia With Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/evaluation-of-cervicalgia-with-headache/30835/

  Cervicogenic headache describes pain referred to the head from a source in the cervical spine. The diagnosis of this disorder is controversial. Some authorities believe that clinical criteria alone are sufficient, while others, including the International Headache Society, require confirmatory tests to establish the diagnosis. A multidisciplinary approach is often required to adequately manage this disorder. A thorough history and physical examination of the neck and occipital region coupled with appropriate diagnostic testing can help to provide an accurate diagnosis of the pain generator or generators. […] The International Headache Society defines diagnostic criteria for cervicogenic headache. The most useful clinical features are pain that radiates from the neck to the fronto-temporal region and pain that is reproduced with neck movements. The diagnostic criteria may help distinguish between cervicogenic headache and migraine symptoms, especially when a history of neck trauma is present.

• #2 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  30% of mothers report headaches after childbirth, but only 4.7% of headaches may be attributed to PSH. […] History, symptoms and physical examination help to differentiate PSH from other causes of headache in the postpartum period. […] Diagnostic Lumbar Puncture (LP) should be avoided, as there is a risk of worsening the headache secondary to an additional dual puncture. […] MRI-brain imaging may be considered when the patient has a non-orthostatic headache or develops after an initial orthostatic headache and also when the onset of the headache is more than 5 days after the suspected dural puncture. […] PSH is generally self-limited and benign. Headache usually resolves within a few days, but the longest reported headache after lumbar puncture lasted for 19 months. […] The patient with inadvertent dural puncture may have chronic headache, backache, neck ache, depression, cranial nerve palsy, subdural hematoma or cerebral venous thrombosis. […] All patients with PSH must be referred to an anesthesiologist within 24 hours of its onset and should be followed till resolution of PSH. […] Current approaches to the diagnosis, treatment and management of PDPH are not uniform in India.

• #2 Solutions for spinal headaches

  https://www.contemporaryobgyn.net/view/spinal-headaches

  Several patient factors can increase the risk of a PDPH, including female gender, pregnancy, lower body mass index, and a history of headaches. […] The type and size of needle used for dural puncture also influences the prevalence of PDPH, with Tuohy needles and cutting/traumatic spinal needles being more likely to cause a PDPH than nontraumatic/pencil point spinal needles. […] Patients with PDPH will most often present with a dull or throbbing headache that is bilateral, occipital-frontal in location, and of varying severity. […] The true hallmark of this condition is a change in the severity of the headache with patient positioning. […] Patients who present with mild PDPH without associated symptoms can often be treated conservatively without the need for intervention by an anesthesiologist.

• #2 Confronting Postdural Puncture Headache in Clinical Practice – Neurology Advisor

  https://www.neurologyadvisor.com/features/confronting-postdural-puncture-headache-in-clinical-practice/

  Postdural puncture headache (PDPH) is a known consequence of lumbar puncture used for the diagnosis of neurological disorders, as well as during epidural anesthesia. The International Classification of Headache Disorders published in 2004 defined PDPH as a positional headache occurring within 7 days of postdural puncture (PDP) that worsens with standing and is relieved on lying down. […] PDPH is a commonly encountered complication of procedures that can result in dural puncture, whether in the setting of diagnostic procedures or as a complication of spinal or epidural anesthesia. The frequency of PDPH varies largely based on both patient and procedure characteristics. PDPH is more common in young, thin women; in patients with a prior history of PDPH; and in patients with a history of a chronic headache disorder.

• #2 Post Lumbar Puncture Headaches – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/post-lumbar-puncture-headaches/

  Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. […] In terms of the prevention and treatment of post-LP headaches, both are equally important in management. […] Size of the dural puncture site is directly proportional to the likelihood of headache development. […] Conclusion: Parallel direction of needle bevel does decrease incidence of post LP headache. […] Conclusion: Replacement of stylet before spinal needle withdrawal, decreases incidence of post LP headache. […] Conclusion: There is no difference in post LP headache incidence with early ambulation vs bed rest after LP. […] Conclusion: Volume of CSF was not a risk factor for post LP headache.

• #2 Post-dural-puncture headache – Wikipedia

  https://en.wikipedia.org/wiki/Post-dural-puncture_headache

  Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). […] PDPH is a common side effect of lumbar puncture and spinal anesthesia. […] Onset occurs within two days in 66% of cases and three days in 90%. […] Although in very rare cases the headache may present immediately after a puncture, this is almost always due to another cause such as increased intracranial pressure and requires immediate attention. […] Using a pencil point rather than a cutting spinal needle decreases the risk. […] The size of the pencil point needle does not appear to make a difference, while smaller cutting needles have a low risk compared to larger ones. […] However, the evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache is moderate-quality and further research should be done. […] Evidence does not support the use of bed rest or intravenous fluids to prevent PDPH. […] PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia.

• #2 Statement on Post-Dural Puncture Headache Management | American Society of Anesthesiologists (ASA)

  https://www.asahq.org/standards-and-practice-parameters/statement-on-post-dural-puncture-headache-management

  If a PDPH is suspected, a member of the anesthesia team should see the patient within 24 hours. The intensity of maternal symptoms may dictate the need for an Epidural Blood Patch (EBP). When PDPH is less severe, which may reflect a smaller dural tear with less CSF leak, conservative therapy may be preferred in the expectation the headache resolves without the need for an EBP. If headache is more significant such that activities of daily life and caring for the baby are compromised, an EBP should be considered. […] All patients with a confirmed or suspected UDP or PDPH need a brief physical exam for the presence or absence of neurologic symptoms (e.g., cranial nerve function, motor reflexes). Patient follow-up should occur within 24-48 hours after an UDP. In the first 24-48 hours, conservative measures for symptomatic relief (e.g., non-opioid analgesics, opioids for severe breakthrough pain, lying flat, adequate hydration) are recommended initially before initiating a TEBP. If the PDPH is severe enough or affects the mother-child interaction, a TEBP should not be delayed.

• #2 Spinal headache: Symptoms, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/spinal-headache

  A spinal headache occurs when cerebrospinal fluid (CSF) leaks through a puncture in the membrane that surrounds the spinal cord. This leak decreases the physical support that CSF provides for the brain, causing a headache to occur. […] A spinal headache often occurs as a complication of a lumbar puncture, which is a diagnostic procedure that involves a doctor taking a sample of CSF from the spinal cord using a needle. […] Around 25% of people who undergo a lumbar puncture develop a spinal headache, which healthcare professionals may refer to as a postdural puncture headache. […] This article discusses the symptoms, causes, diagnosis, treatment, and possible duration of a spinal headache. […] A doctor will often diagnose a spinal headache using a clinical evaluation based on a persons symptoms.

• #2 Let’s make misdiagnosis the exception – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/lets-make-misdiagnosis-the-exception/

  Another common misdiagnosis is new daily persistent headache (NDPH). […] NDPH is usually treated with medications, which, like treatments for migraine, are almost entirely ineffective for SIH. […] Cervicogenic headache can also be worse with upright posture, similar to SIH. […] A CT of the head may show some evidence of SIH but is often negative. Brain MRI with gadolinium enhancement is the standard-of-care initial diagnostic imaging for ALL patients suspected of having SIH. […] Despite increasing awareness, misdiagnosis remains the rule rather than the exception when it comes to SIH. […] For experienced radiologists, neurosurgeons, and neurologists, SIH and Chiari I are easily distinguished. […] It is important that treatment of the underlying spinal CSF leak is not overlooked.

• #2 Post lumbar puncture headache: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2660496/

  Generally, 85% of headaches after lumbar puncture will resolve without any specific treatment. […] However, if conservative measures fail to resolve headaches after lumbar puncture, then specific treatment is indicated 72h after the onset of pain, as it would avert the catastrophic complications of subdural haematoma and seizures that could be fatal. […] The aim of specific management of headache after lumbar puncture is to replace the lost CSF, seal the puncture site and control the cerebral vasodilatation. […] The concept of the epidural blood patch was developed after the observation made on patients who had bloody tap, in whom the incidence of headache was low. […] The presence of fever, local infection in the back and bleeding disorders are the main contraindications for this procedure. […] This procedure has a success rate of about 70-98% and can be repeated if it fails to resolve the symptoms at the first attempt.

• #2 Let’s make misdiagnosis the exception – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/lets-make-misdiagnosis-the-exception/

  In recent years, the awareness of spontaneous intracranial hypotension (SIH) has increased such that more patients are being diagnosed correctly. But sadly, misdiagnosis remains the rule rather than the exception. […] Because SIH has an identifiable underlying cause, a spinal cerebrospinal (CSF) leak, it is often treatable with the guidance of specialized diagnostic testing as needed. […] The estimated incidence is based on a single urban emergency department study roughly estimating the annual incidence at 5 per 100,000. […] More accurate estimates are needed. […] We do know that SIH isn’t nearly as common as most other causes of headache, which contributes to low awareness, misdiagnosis, and delayed diagnosis. […] Migraine is the most common misdiagnosis among patients with SIH. An important hallmark of SIH is that migraine treatments are almost entirely ineffective.

• #2 Spinal Headaches: Causes, Symptoms, Types and Treatment

  https://www.medicoverhospitals.in/diseases/spinal-headaches/

  Diagnosing spinal headaches involves a detailed understanding of the patients medical history, symptoms, and recent procedures. […] Healthcare providers follow a structured approach to ensure the headache is truly linked to a spinal fluid leak caused by procedures like a lumbar puncture or spinal anesthesia. […] Key steps in diagnosing spinal headaches include: […] Medical History Review: The doctor asks whether youve had a recent spinal tap, epidural anesthesia or any procedure involving your spine. This development is essential in the process of diagnosing spinal headaches. […] Symptom Evaluation: Spinal headaches are characterized by postural symptoms; they are worse while sitting or standing and improve on lying flat. This pattern allows doctors to differentiate spinal headaches from other types.

• #2 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  If you’ve had a spinal tap in the last 14 days, the diagnosis is often obvious. In that case, you usually don’t need tests. […] If you haven’t had a spinal tap, providers typically use magnetic resonance imaging (MRI) to diagnose the source of the headache. […] To manage most spinal headaches, healthcare providers recommend lying down in a flat position. […] If a spinal headache lasts more than a few days, your provider may recommend an epidural blood patch. […] The prognosis (outlook) for a spinal headache is generally good. […] About 85% of all spinal headaches get better without treatment. […] Contact your healthcare provider if you experience a severe headache after a spinal tap, especially if it lasts longer than 24 hours. […] If you experience a severe headache after getting a spinal tap or epidural, tell your healthcare provider.

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