Materiały źródłowe

• #1 Postdural Puncture Headache – StatPearls – NCBI Bookshelf

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

  The reported incidence in the literature has been estimated to be quite variable but may result after approximately 10% to 40% of lumbar puncture procedures or may be as low as 2% when small gauge (24 gauge) noncutting spinal needles are used. Symptoms of PDPH typically occur within 48 to 72 hours of having the lumbar puncture but can be delayed for as long as months after the procedure. […] The underlying cause of the PDPH is an intentional dural puncture performed during a lumbar puncture that is necessary for diagnostic myelography, the instillation of various therapeutic medications into lumbar subarachnoid space, or following the inadvertent dural puncture that results while administering epidural anesthesia or when medications are injected for spinal pain. Other low-CSF pressure symptoms suggestive of intracranial hypotension can also develop spontaneously or following craniotomy, placement of intraventricular shunts for CSF diversion, brain/spinal trauma, or spinal surgery.

• #1 Post-dural-puncture headache – Wikipedia

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

  Estimates for the overall incidence of PDPH vary between 0.1% and 36%. It is more common in younger patients (especially in the 18-30 age group), women (especially those who are pregnant), and those with a low body mass index (BMI). The low prevalence in elderly patients may be due to a less stretchable dura mater. […] PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The frequency with which patients should be observed after a neuraxial block or an LP is unclear. Inpatients should be seen by a member of the healthcare team at least once per day to ensure full neurological recovery and absence of headache. […] PDPH is a known complication of intentional dural puncture during an LP, spinal procedure or inadvertent dural puncture during an epidural procedure. Its incidence, as reported in the literature, varies widely. Following spinal anesthesia, rates ranging from 2% to 40% have been described, depending on needle gauge. […] A variety of risk factors for PDPH have been studied, often retrospectively, via chart review. Some prospective studies have followed cohorts of patients after dural puncture, but there are few relevant randomized, controlled trials.

• #1

  https://journals.lww.com/ijaweb/fulltext/2018/62110/incidence_and_management_of_post_dural_puncture.9.aspx

  Post-dural puncture headache (PDPH) is one of the complications following spinal anaesthesia (SA) and accidental dural puncture (ADP). […] In 2 years, we found that the incidence of PDPH in the patients who received SA was 3.9% and 25% in the ADP group. […] The incidence of PDPH following ADP varies and can be 80-86% in the obstetric population. […] Our incidence of PDPH following SA was 16/407 patients in the IDP group (3.9%). Incidence of headache is lesser with dural fibre splitting needle such as Whitacre needle rather than dura cutting needles such as Quincke needle. […] The incidence of PDPH after ADP in parturients is around 50-86%. […] We encountered a relatively low incidence of 25% (20 out of 80) patients in the ADP group presenting with PDPH. […] The incidence of PDPH following ADP is 25% in our hospital which constitutes a non-obstetric general population. This is much lower than that reported from obstetric centres. PDPH in this group can be effectively controlled with drug-based treatment.

• #1 Post‐dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-022-02785-0

  In this study, we aimed to evaluate the incidence, risk factors and clinical characteristics of PDPH in the inpatient setting of the main tertiary neurology hospital in Kuwait. To our knowledge, this work represents the first comprehensive description of PDPH from a population of the Arabian Gulf Region. […] A total of 285 patients were included; 225 females (78.9%), mean age of 32.9 years. PDPH was reported by 84 patients (29.5%), with mean headache onset of 1.7 days, and mean duration of 2.4 days. The commonest headache type was dull aching in 49 patients (58.3%). Headache severity was mild to moderate in 64 patients (76.2%), with mean NRS of 4.1. Most PDPH (99.3%) resolved with conservative medical management, with only 2 patients (0.7%) requiring epidural blood patch. In multivariate logistic regression model, there was a statistically significant correlation between development of PDPH and young age (p=0.001), female gender (p=0.001), low BMI (p=0.001), pre-LP headache (p=0.001), history of previous PDPH (p=0.001), and number of LP attempts (p=0.001). PDPH was statistically significantly higher in patients with optic neuritis (p=0.009), and cerebral venous thrombosis (p=0.007), and lower in patients with peripheral neuropathy (p=0.011) and spinal muscular atrophy (p=0.042). […] Findings from clinical practice in the main tertiary neurology hospital in Kuwait were in line with literature findings. Younger age, female gender, lower BMI, pre-procedural headache, previous history of PDPH, and number of LP attempts were found to be independent risk factors for developing PDPH.

• #1 INCIDENCE AND FACTORS ASSOCIATED WITH POST SPINAL PUNCTURE HEADACHE (PSPH) IN OBSTETRIC MOTHERS WHO UNDERWENT SPINAL ANESTHESIA: A PROSPECTIVE COHORT STUDY | Journal of Population Therapeutics and Clinical Pharmacology

  https://jptcp.com/index.php/jptcp/article/view/3092

  The overall incidence of postspinal headache was 39.72%. […] Factors with higher odds of developing postspinal headache included, Women with a Lower Body mass index (BMI) has been shown to be associated with higher risk of PSPH (.32+.467, t value 11.662, p= 0.000), undergoing 2 puncture attempts (.15+.355, t value 7.089, p =0.000),3 puncture attempts (.51+.501, t value 17.294, p =0.000), and 3 puncture attempts (.32+.467, t value 11.662, p =0.000), a level of puncture entry at L3-4 (.43+.496, t value 14.862, p =0.000) had lower odds of developing PSH, initiation of ambulation 24 h after spinal anesthesia (.46+.499, t value 15.602, p=0.000),cutting needle (.69+.463, t value 25.556, p=0.000), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (.73+.447, t value 27.770, p=0.000),having lost 1500 ml of blood intraoperatively (.47+.500,t value 15.928, p=0.000), having a previous history of chronic headache (.57+.496, t value 19.580, p=0.000), and those prescribed weak opioids (.91+.285, t value 54.563, p=0.000).

• #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. […] Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia. […] Risk factors for spinal headaches include: Being between the ages of 18 and 30, Being female, Being pregnant, Having a history of frequent headaches, Undergoing procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord, Having a small body mass.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The preponderance of evidence suggests that in the adult population, younger age may be associated with an increased risk of PDPH (High Level of Certainty). […] The preponderance of evidence suggests that female sex is associated with an increased risk of PDPH (High Level of Certainty). […] Evidence does not suggest that BMI consistently correlates with an increased risk of PDPH (Moderate Level of Certainty). […] The preponderance of evidence suggests that a history of headaches (chronic, contemporaneous, or prior PDPH) may be associated with an increased risk of PDPH. The association specifically with migraine is less clear (Moderate Level of Certainty). […] Evidence regarding the effect of active pushing on PDPH during the second stage of labor following dural puncture with an epidural needle is conflicting (Low Level of Certainty).

• #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 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. […] Reviews by Park et al and Arevalo-Rodriguez et al have shown a lack of evidence supporting bed rest for the prevention of PDPH. […] The most important modifiable factors that can reduce the risk for PDPH are needle size and shape, bevel orientation, and stylet replacement. […] PDPH is usually a self-limited condition, with resolution in nearly 75% of patients within 1 week.

• #1 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  According to the International Classification of Headache Disorder, postdural puncture headache (PDPH) is defined as a headache occurring within 5 days after lumbar puncture (LP), which is aggravated when standing or sitting and relieved when lying flat. The prevalence of PDPH is higher in pregnant women. It is a common complication of lumbar puncture, which is likely due to the loss of cerebrospinal fluid (CSF) into the epidural space through the dural tear. The reported incidence of PDPH varies from 10 to 40% depending on age, gender, and needle size. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. The smaller needle diameter reduces the incidence of PDPH.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  Compared to cutting needles, non-cutting spinal needles are associated with decreased risk of PDPH (High Level of Certainty). […] When using cutting needles, narrower gauge needles decrease the risk of PDPH (High Level of Certainty). […] Evidence suggests an association between the number of attempts at LP and the risk of PDPH (Moderate Level of Certainty). […] Evidence suggests that increased operator experience level decreases the incidence of PDPH, but net benefit may be small (Moderate Level of Certainty). […] Evidence suggests that all neuraxial techniques (ie, spinal, epidural, and CSE) have similar PDPH risk profiles (Moderate Level of Certainty). […] Evidence does not suggest an association of PDPH with the level of epidural insertion (Moderate Level of Certainty). […] Evidence suggests a decreased risk of PDPH with techniques performed with the patient in the lateral decubitus position (Moderate Level of Certainty).

• #1 Headache associated with spontaneous spinal CSF leak | MedLink Neurology

  https://www.medlink.com/articles/headache-associated-with-spontaneous-spinal-csf-leak

  Epidemiology: The actual incidence and the prevalence of the disorder have not been determined, as spontaneous spinal CSF leak is an underdiagnosed cause of chronic headaches. A community-based study estimated the prevalence at 1 per 50,000. An emergency department-based study reported an estimated annual incidence of 5 per 100,000. The disorder can occur at any age but is rare in childhood. The vast majority of patients are adults (peak incidence at about age 40), and there is a female preponderance (female to male ratio of about 2 to 1). […] Unfortunately, our knowledge of the true incidence and prevalence of the disorder is affected by misdiagnosis. It has been found that up to 94% of individuals with spontaneous intracranial hypotension have been misdiagnosed, with the most common misdiagnoses being migraine, meningitis, psychological disorders, or even malingering.

• #1 Spinal Cord Injury and Migraine Headache: A Population-Based Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135550

  Migraine headaches are a common neurological condition, negatively impacting health and quality of life. Among potential risk factors for migraine headache, risk of migraine headaches was elevated in individuals with spinal cord injury (SCI). […] The primary objective of this study was to further examine the association between SCI and migraine headache, controlling for potential confounding variables. […] The multivariable age- and sex-adjusted model revealed a strong association between SCI and migraine headache, with an adjusted odds ratio for migraine of 4.82 (95% confidence interval [3.02, 7.67]) among those with SCI compared to those without SCI. […] In conclusion, this study established a strong association between SCI and migraine headache. Further research is needed to explore the possible mechanisms underlying this relationship. Improvements in clinical practice to minimize this issue could result in significant improvements in quality of life.

• #1 Evaluation of Cervicalgia With Headache

  https://practicalneurology.com/articles/2010-nov-dec/evaluation-of-cervicalgia-with-headache

  Cervicogenic headache prevalence is estimated at 0.5 to four percent, but may be as high as 20 percent of patients presenting with severe chronic headaches. […] Up to 50 percent of patients have a history of migraine or tension-type headache. […] The mean age of patients with this condition is 43 years; the condition is more common in women. […] 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. […] Approximately 30 percent of cervicogenic headache patients present with a history of neck trauma.

• #1 Ventral spinal cerebrospinal fluid leak as the cause of persistent post–dural puncture headache in children in: Journal of Neurosurgery: Pediatrics Volume 11 Issue 1 (2013) Journals

  https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/11/1/article-p48.xml

  Headache occurs after dural puncture in about 1%25% of children who undergo the procedurea rate similar to that seen in adults. […] The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. […] They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Its incidence varies widely, with rates ranging from 2% to 40%, depending on procedural and patient factors. PDPH is usually postural and presents within the first 5 days of witnessed or suspected dural puncture. […] Despite numerous reviews on the prevention and management of PDPH, most lack structured recommendations. This is because data are inconclusive, as studies are generally small and heterogeneous, often mixing preventative and therapeutic treatments. Current multisociety guidelines aim to fill this void and provide comprehensive information with strength and certainty of evidence.

• #1 Post‐dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-022-02785-0

  Post-dural puncture headache (PDPH), formerly known as post-lumbar puncture headache, is a well-known adverse event that follows diagnostic and/or therapeutic puncture of the dura, or accidentally, following spinal anesthesia. The classical features of PDPH according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) include headache that occurs within 5 days of lumbar puncture (LP), that is aggravated with standing or sitting position and relieved with lying down, and remits spontaneously within 2 weeks, or after sealing of the leak with epidural lumbar patch. […] This particular type of headache has been an area of interest to physicians from different specialties, and several clinical studies have attempted to identify procedure- and non-procedure-related risk factors in the literature. Several modifiable and non-modifiable independent risk factors for PDPH have been documented in both anesthesiology and neurology studies. Class I and II evidence regarding the development of PDPH in literature included; female gender, age between 20 and 50 years, lower body mass index (BMI), previous history of PDPH, larger needle diameter, use of cutting needles, perpendicular insertion of the needle bevel to the long axis of the spine, and pregnancy. As a result, the incidence of PDPH vary widely in the literature, depending on the characteristics of the studied populations, and the different applied techniques. However, it was estimated that around one-third of the procedures can be complicated with headache.

• #1 INCIDENCE AND FACTORS ASSOCIATED WITH POST SPINAL PUNCTURE HEADACHE (PSPH) IN OBSTETRIC MOTHERS WHO UNDERWENT SPINAL ANESTHESIA: A PROSPECTIVE COHORT STUDY | Journal of Population Therapeutics and Clinical Pharmacology

  https://jptcp.com/index.php/jptcp/article/view/3092

  This was significantly associated with needle design, amount of cerebro-spinal fluid lost, body mass index (BMI), number of puncture attempts, time at start of ambulation, amount of intraoperative blood loss, level of puncture entry, previous diagnosis with chronic headache, and class of analgesic prescribed.

• #1 Post-Dural Puncture Headache – Core EM

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

  Epidemiology: 10-30% of patients post-LP will develop a headache (Bezov 2010) […] Likely underreported.

• #1 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  Cluster headache (CH) affects 0.1% of the population with an incidence of 2.07–9.8/100,000 person-years-habitants, a mean prevalence of 53/100,000 inhabitants (3–150/100,000 inhabitants). […] The incidence has been difficult to estimate due to the relatively low frequency of CH and systematic underdiagnosis. A study in a specialist practice setting in the USA observed 40 new cases of TAC in 4 years, mostly CH, which accounted for 5.3% of all headaches. […] Fischera et al. reported in a meta-analysis of 16 studies that examined prevalence frequencies from 3 to 150/100,000 persons, and the combined lifetime prevalence was 124/100,000 (95% CI: 101–151), and the mean annual prevalence was 53/100,000 (95% CI: 26–95). […] Variations can be found in epidemiological data from different series; Stovner et al. determined that Multiple Linear Regression analyses explained less than 30% of the variations; other methodological factors influencing these differences are year of publication, sample size, the inclusion of probable diagnoses, sampling method, screening question, and research setting.

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

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

  Studies show that a spinal headache develops in approximately 10% to 40% of lumbar puncture procedures. […] Spinal headaches are most common in 20-to-40-year-olds who receive epidurals during labor. […] The prognosis (outlook) for a spinal headache is generally good. About 85% of all spinal headaches get better without treatment. About 60% to 70% of people who have an epidural blood patch no longer have a spinal headache within 24 hours.

• #1

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/10000/incidence_and_associated_factors_of_post_dural.10.aspx

  Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patients age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities. […] The incidence of PDPH in research volunteers is ~6%, in patients for whom the NA is for clinical purposes; the prevalence of PDPH ranges from 10% to over 80% in different aged patients who underwent either epidural or spinal or combined block. […] The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. […] The incidence and associated risk factors of PDPH in orthopaedic patients has not been well studied in the study area and identifying its incidence and factor associated with it would increase patient satisfaction, reduced treatment cost and decrease hospital stay.

• #1 Spinal Cord Injury and Migraine Headache: A Population-Based Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135550

  The prevalence of migraine was higher in the population with SCI (28.9%) than in those without SCI (9.9%). […] In the multivariable model, the adjustment for age and sex strengthened the results: the AOR for migraine headache was 4.82 (3.02, 7.67) among those with SCI. […] Compared to the sample without SCI, individuals with SCI reported significantly poorer self-perceived health scores (Chi-square test, p0.001). Migraine headaches had a significant negative impact on self-perceived health in individuals with SCI (Chi-square test, p = 0.03) but not the non-SCI sample. […] An important finding of this work is that SCI and headaches have a substantial negative impact on self-perceived health after SCI. […] In summary, we report a strong relationship between migraine headache and SCI after controlling for major confounding variables, and show that migraine headaches and SCI may compound self-perceptions of health when occurring together.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The use of fibrin glue in the treatment of PDPH has been associated with anaphylaxis and aseptic meningitis, although it is not possible to quantify risk (Low Level of Certainty). […] The current guidelines provide structured and evidence-based recommendations on pertinent aspects of PDPH, including risk factors, diagnosis, preventative and prophylactic measures, and, finally, therapeutic options and their side effects.

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  Evidence is insufficient to confirm benefit of any technique used to identify the epidural space on reduction of the incidence of PDPH (Low Level of Certainty). […] Evidence suggests that the choice of needle for LP does not alter the risk of traumatic tap and the risk of PDPH (Moderate Level of Certainty). […] Evidence does not support routine use of bed rest to treat PDPH, but it may be used as a temporizing measure for symptomatic relief (Grade C; Low Level of Certainty). […] Evidence does not support routine use of abdominal binders to treat PDPH (Grade D; Low Level of Certainty). […] Evidence does not support routine use of aromatherapy to treat PDPH (Grade D; Low Level of Certainty). […] Evidence does not support routine use of hydrocortisone, theophylline, and gabapentin in the management of PDPH (Grade D; Low Level of Certainty).

• #1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The efficacy of GONB for PDPH following dural puncture with wider gauge needles is unclear (Low Level of Certainty). […] Evidence does not support routine use of fibrin glue to treat PDPH (Grade I; Low Level of Certainty). […] The diagnosis of PDPH is established on clinical presentation, and cranial imaging is usually not needed for routine assessment of patients with typical PDPH symptoms. […] Current evidence is insufficient to assess the risk-benefit balance for routine cranial imaging before EBP for PDPH (Low Level of Certainty). […] The risk of epidural hematoma is low when performing neuraxial procedures in obstetric patients with a platelet count 70,000 x 10^6/L providing there is no defect in platelet function or other abnormality of coagulation (Moderate Level of Certainty).

• #1 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Postdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache. […] One hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p 0.05). […] A recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache.

• #2 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Postdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache. […] One hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p 0.05). […] A recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache.

• #2 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  According to the International Classification of Headache Disorder, postdural puncture headache (PDPH) is defined as a headache occurring within 5 days after lumbar puncture (LP), which is aggravated when standing or sitting and relieved when lying flat. The prevalence of PDPH is higher in pregnant women. It is a common complication of lumbar puncture, which is likely due to the loss of cerebrospinal fluid (CSF) into the epidural space through the dural tear. The reported incidence of PDPH varies from 10 to 40% depending on age, gender, and needle size. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. The smaller needle diameter reduces the incidence of PDPH.

• #2 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) […] Spontaneous Intracranial Hypotension (with cough or sneeze) occurs in 5 per 100,000 […] Rare under age 13 years old or over age 60 years old.

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

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

  Post-dural puncture headaches occur after ~20% (range 2-40%) of dural punctures, most commonly in younger patients (31-50 years). […] There are a few technique-related factors that can increase the risk of a post-dural puncture headache: needle size: incidence decreases with small caliber spinal needles. […] Initial treatment is supportive (rehydration, analgesia, caffeine) and most cases (85%) resolve without further intervention.

• #2 Post-lumbar puncture headache | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2012/04/post-lumbar-puncture-headache

  Post-dural puncture headache (PDPH) is characterised by the occurrence of a headache with a definite orthostatic component within five days of a lumbar puncture. The incidence depends on a number of factors. Younger women with a previous history of headaches appear to be at highest risk. The incidence can be significantly reduced by using a thin lumbar puncture needle with an atraumatic tip. The condition is self-limiting and harmless, but leads to significant morbidity. […] The risk of developing a headache as a result of a lumbar puncture depends on a number of factors, and the incidence will therefore vary widely, depending on the populations studied and the needles and techniques that have been used. […] In a review of literature from 1966 to 2000, Evans et al. found that when needles of gauge 20-22 gg were used (typical of diagnostic spinal puncture) the incidence was 20-40%. Post-dural puncture headache occurs roughly twice as often with diagnostic lumbar puncture as with spinal anaesthesia.

• #2 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The preponderance of evidence suggests that in the adult population, younger age may be associated with an increased risk of PDPH (High Level of Certainty). […] The preponderance of evidence suggests that female sex is associated with an increased risk of PDPH (High Level of Certainty). […] Evidence does not suggest that BMI consistently correlates with an increased risk of PDPH (Moderate Level of Certainty). […] The preponderance of evidence suggests that a history of headaches (chronic, contemporaneous, or prior PDPH) may be associated with an increased risk of PDPH. The association specifically with migraine is less clear (Moderate Level of Certainty). […] Evidence regarding the effect of active pushing on PDPH during the second stage of labor following dural puncture with an epidural needle is conflicting (Low Level of Certainty).

• #2 Post-dural-puncture headache – Wikipedia

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

  Estimates for the overall incidence of PDPH vary between 0.1% and 36%. It is more common in younger patients (especially in the 18-30 age group), women (especially those who are pregnant), and those with a low body mass index (BMI). The low prevalence in elderly patients may be due to a less stretchable dura mater. […] PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia.

• #2 INCIDENCE AND FACTORS ASSOCIATED WITH POST SPINAL PUNCTURE HEADACHE (PSPH) IN OBSTETRIC MOTHERS WHO UNDERWENT SPINAL ANESTHESIA: A PROSPECTIVE COHORT STUDY | Journal of Population Therapeutics and Clinical Pharmacology

  https://jptcp.com/index.php/jptcp/article/view/3092

  The overall incidence of postspinal headache was 39.72%. […] Factors with higher odds of developing postspinal headache included, Women with a Lower Body mass index (BMI) has been shown to be associated with higher risk of PSPH (.32+.467, t value 11.662, p= 0.000), undergoing 2 puncture attempts (.15+.355, t value 7.089, p =0.000),3 puncture attempts (.51+.501, t value 17.294, p =0.000), and 3 puncture attempts (.32+.467, t value 11.662, p =0.000), a level of puncture entry at L3-4 (.43+.496, t value 14.862, p =0.000) had lower odds of developing PSH, initiation of ambulation 24 h after spinal anesthesia (.46+.499, t value 15.602, p=0.000),cutting needle (.69+.463, t value 25.556, p=0.000), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (.73+.447, t value 27.770, p=0.000),having lost 1500 ml of blood intraoperatively (.47+.500,t value 15.928, p=0.000), having a previous history of chronic headache (.57+.496, t value 19.580, p=0.000), and those prescribed weak opioids (.91+.285, t value 54.563, p=0.000).

• #2 Post-lumbar puncture headache | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2012/04/post-lumbar-puncture-headache

  In 2001, Strupp et al. showed that over 12% of 115 patients who were subjected to diagnostic lumbar puncture with a 22 gg (0.7 mm) atraumatic needle suffered post-dural puncture headache, while over 24% of 115 who were given a lumbar puncture with a 22 gg traumatic needle suffered a headache. […] Post-dural headache may also occur in connection with unintentional dural perforation, for example in unsuccessful attempts to insert an epidural catheter in obstetric patients, but this is relatively rare (in about 1%). It is nonetheless worth noting that the majority of birthing mothers suffering a perforated dura develop post-dural puncture headache. […] The most important modifiable risk factor is the needle used in the procedure. The calibre of the needle is directly associated with the incidence of post-dural puncture headache. The larger the needle, the larger the perforation in the dura, and the higher the risk of a persistent cerebrospinal fluid leak. However, needles that are too thin cannot be used, for practical reasons. […] Using an atraumatic needle can also substantially reduce the incidence of post-dural puncture headache.

• #2 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Risk factors associated with PDPH were analyzed further. […] Consequently, backward multiple logistic regression analysis was used to determine the association of PDPH. Accordingly, the output of multiple logistic regression models revealed that needle size, number of CSF drops, and multiple attempts were significantly independent predictors of PDPH (p 0.05). […] The findings of this study revealed that multiple attempts during spinal anesthesia administration were significantly associated with PDPH. […] The findings of this study revealed that a small spinal needle is significantly superior to a large spinal needle regarding the occurrence of PDPH. In addition, multiple attempts and the amount of CSF drops were significantly associated with PDPH.

• #2 Epidemiology and Outcome of Postural Headache Management in Spontaneous Intracranial Hypotension | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/26/6/582

  Spontaneous intracranial hypotension is a postural headache syndrome unrelated to dural puncture. […] We investigated the epidemiologic features and treatment outcomes of this condition. […] The mean age of the study population was 43 [plusmn] 16 years, with a female:male ratio of 3.4:1.0. […] Spontaneous intracranial hypotension was more common in women than men, was not uniformly responsive to epidural blood patch, and had significant comorbidities. […] The management of postural headache in spontaneous intracranial hypotension by other techniques to restore cerebrospinal fluid dynamics and prevent its leakage should be investigated.

• #2 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The frequency with which patients should be observed after a neuraxial block or an LP is unclear. Inpatients should be seen by a member of the healthcare team at least once per day to ensure full neurological recovery and absence of headache. […] PDPH is a known complication of intentional dural puncture during an LP, spinal procedure or inadvertent dural puncture during an epidural procedure. Its incidence, as reported in the literature, varies widely. Following spinal anesthesia, rates ranging from 2% to 40% have been described, depending on needle gauge. […] A variety of risk factors for PDPH have been studied, often retrospectively, via chart review. Some prospective studies have followed cohorts of patients after dural puncture, but there are few relevant randomized, controlled trials.

• #2 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. […] Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia. […] Risk factors for spinal headaches include: Being between the ages of 18 and 30, Being female, Being pregnant, Having a history of frequent headaches, Undergoing procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord, Having a small body mass.

• #2 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  Evidence is insufficient to confirm benefit of any technique used to identify the epidural space on reduction of the incidence of PDPH (Low Level of Certainty). […] Evidence suggests that the choice of needle for LP does not alter the risk of traumatic tap and the risk of PDPH (Moderate Level of Certainty). […] Evidence does not support routine use of bed rest to treat PDPH, but it may be used as a temporizing measure for symptomatic relief (Grade C; Low Level of Certainty). […] Evidence does not support routine use of abdominal binders to treat PDPH (Grade D; Low Level of Certainty). […] Evidence does not support routine use of aromatherapy to treat PDPH (Grade D; Low Level of Certainty). […] Evidence does not support routine use of hydrocortisone, theophylline, and gabapentin in the management of PDPH (Grade D; Low Level of Certainty).

• #2 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/7/471

  The use of fibrin glue in the treatment of PDPH has been associated with anaphylaxis and aseptic meningitis, although it is not possible to quantify risk (Low Level of Certainty). […] The current guidelines provide structured and evidence-based recommendations on pertinent aspects of PDPH, including risk factors, diagnosis, preventative and prophylactic measures, and, finally, therapeutic options and their side effects.

• #2 Spinal Cord Injury and Migraine Headache: A Population-Based Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135550

  Migraine headaches are a common neurological condition, negatively impacting health and quality of life. Among potential risk factors for migraine headache, risk of migraine headaches was elevated in individuals with spinal cord injury (SCI). […] The primary objective of this study was to further examine the association between SCI and migraine headache, controlling for potential confounding variables. […] The multivariable age- and sex-adjusted model revealed a strong association between SCI and migraine headache, with an adjusted odds ratio for migraine of 4.82 (95% confidence interval [3.02, 7.67]) among those with SCI compared to those without SCI. […] In conclusion, this study established a strong association between SCI and migraine headache. Further research is needed to explore the possible mechanisms underlying this relationship. Improvements in clinical practice to minimize this issue could result in significant improvements in quality of life.

• #3

  https://www.msjonline.org/index.php/ijrms/article/view/9952

  Multiple complications including hypotension, nausea, vomiting, urinary retention, transient neurological symptoms and headache have been associated with spinal anaesthesia. Importantly, post dural puncture headache (PDPH) varies with the type and size of spinal needle employed for inducing anaesthesia. […] The previous history of PDPH was observed in 20.39% patients. […] The comparative study showed that the PDPH was observed in 12 (15.7%) patients in group 1 while the group 2 revealed PDPH in only 2 (2.6%) patients. […] Thus 29-G spinal needle can be regarded as a better option to reduce PDPH in patients subjected to spinal anaesthesia for elective cesarean in contrast to the use of 25-G Quincke spinal needle. […] Post-dural puncture headache: epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy.

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