Materiały źródłowe

• #1 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #2 Oral Ergotamine versus Theophylline as Treatment of Post-dural Puncture Headache (PDPH) in Cesarean Section: A Randomized Clinical Trial

  https://openanesthesiajournal.com/VOLUME/17/ELOCATOR/e187407072303131/FULLTEXT/

  Post Dural Puncture Headache is (PDPH) a relatively common complication of spinal anesthesia. […] Early treatment of headaches is symptomatic and supportive, including rest, fluid administration, medication, and eventually the Epidural Blood Patch (EBP). […] The ergotamine C tablets cause cerebral vasoconstriction through stimulation of alpha-adrenergic receptors and norepinephrine reuptake inhibition. […] Theophylline tablets, which are among methyl xanthines, cause cerebral vasoconstriction through inhibition of phosphodiesterase and increase in cellular CAMP concentration and antagonistic effects of adenosine receptors and can be used to treat PDPH. […] Various studies have investigated the efficacy of injecting caffeine, theophylline, and aminophylline intravenously in the prevention and treatment of PDPH, with different results reported.

• #3 Solutions for spinal headaches

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

  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. […] Several patient factors can increase the risk of a PDPH, including female gender, pregnancy, lower body mass index, and a history of headaches. Furthermore, vaginal delivery and excessive pushing during labor can increase the risk of a spinal headache after a postdural puncture. […] 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.

• #4 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Large spinal needles produce large dural perforations while smaller needles produce small dural perforations with lower incidence of headache. […] A recent study shows the incidence of PLPHA decreases with higher gauge Quincke needles as follows: 16 to 19 G, about 70%; 20 to 22 G, 20 to 40%; and 24 to 27 G, 5 to 12%. […] The author of Cochrane review in 2017 reviewed 66 RCTs found out a traumatic tip resulted in a higher risk of PDPH compared to atraumatic tips, no difference with various sizes of large and small traumatic gauges and no significant differences with a higher gauge to a smaller gauge, in atraumatic needles. […] Use of smaller epidural needles (18- vs. 16-gauge) is associated with a lower incidence and severity of PDPH. […] Using 18G special Sprotte epidural needle results less PDPH than 17G Tuohy (55.5% vs. 100%).

• #5 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 can be significantly reduced by using a thin lumbar puncture needle with an atraumatic tip. […] There is substantial evidence for recommending the use of a thin, atraumatic needle to reduce the incidence. […] The risk of inflicting a post-dural puncture headache on the patient is substantially reduced by using a needle with a small diameter and an atraumatic point. […] As previously mentioned, using an atraumatic needle can also substantially reduce the incidence of post-dural puncture headache. […] The calibre of the needle is directly associated with the incidence of post-dural puncture headache. […] A higher number of punctures, due to inexperience on the part of those performing the lumbar puncture, may increase the incidence of post-dural puncture headache somewhat. […] Replacing the mandrin in the needle before the needle is removed has also proved to be beneficial, particularly when atraumatic needles are used. […] The incidence of these headaches can be reduced by using thin atraumatic needles in the procedure.

• #6 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Large spinal needles produce large dural perforations while smaller needles produce small dural perforations with lower incidence of headache. […] A recent study shows the incidence of PLPHA decreases with higher gauge Quincke needles as follows: 16 to 19 G, about 70%; 20 to 22 G, 20 to 40%; and 24 to 27 G, 5 to 12%. […] The author of Cochrane review in 2017 reviewed 66 RCTs found out a traumatic tip resulted in a higher risk of PDPH compared to atraumatic tips, no difference with various sizes of large and small traumatic gauges and no significant differences with a higher gauge to a smaller gauge, in atraumatic needles. […] Use of smaller epidural needles (18- vs. 16-gauge) is associated with a lower incidence and severity of PDPH. […] Using 18G special Sprotte epidural needle results less PDPH than 17G Tuohy (55.5% vs. 100%).

• #7 Post-dural-puncture headache – Wikipedia

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

  Using a pencil point rather than a cutting spinal needle decreases the risk. […] Modern, atraumatic needles such as the Sprotte or Whitacre spinal needle leave a smaller perforation and reduce the risk for PDPH. […] 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.

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

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

  Theres generally nothing you can do to prevent a spinal headache. Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle. […] Sometimes, these measures dont relieve the pain. If a spinal headache lasts more than a few days, your provider may recommend an epidural blood patch. During this procedure, a provider injects a small amount of your blood over the hole thats leaking CSF. When the blood clots, it seals the hole.

• #9 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Parallel orientation separates the dural fibers rather than cuts them, less damage and facilitates dural hole closure on withdrawing. […] There is Class III evidence in anesthesiology literature that indicate less incidence of PLPHA if the bevel is inserted parallel to the dural fibers. […] To date there are five observational studies that shows reduced incidence of PDPH after SA (by 50% or greater) if the bevel is parallel rather than perpendicular. […] Replacements of the stylet before withdrawing the needle decrease the incidence of PDPH when using a noncutting needle and unknown for Quincke needle. […] A randomized controlled study on 600 patients report shows that replacing stylet has low PDPH (5% with a p < 0.005) than patients without replacing (16%). [...] These therapies aim to decrease CSF loss through the dural hole and restore CSF with additional fluid intake and bed rest.

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

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

  Needle size must however be large enough to withdraw fluid safely, efficiently, and measure accurate opening pressures. Spinal needles 22G may give false opening pressure readings and take as long as 6 minutes to withdraw 2mL of CSF, therefore the smallest recommended size needle for diagnostic and therapeutic LPs is 22G. […] 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: Bed rest of any duration after LP does not decrease the incidence of post LP headache. […] Conclusion: Volume of CSF was not a risk factor for post LP headache.

• #11 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Parallel orientation separates the dural fibers rather than cuts them, less damage and facilitates dural hole closure on withdrawing. […] There is Class III evidence in anesthesiology literature that indicate less incidence of PLPHA if the bevel is inserted parallel to the dural fibers. […] To date there are five observational studies that shows reduced incidence of PDPH after SA (by 50% or greater) if the bevel is parallel rather than perpendicular. […] Replacements of the stylet before withdrawing the needle decrease the incidence of PDPH when using a noncutting needle and unknown for Quincke needle. […] A randomized controlled study on 600 patients report shows that replacing stylet has low PDPH (5% with a p < 0.005) than patients without replacing (16%). [...] These therapies aim to decrease CSF loss through the dural hole and restore CSF with additional fluid intake and bed rest.

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

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

  Needle size must however be large enough to withdraw fluid safely, efficiently, and measure accurate opening pressures. Spinal needles 22G may give false opening pressure readings and take as long as 6 minutes to withdraw 2mL of CSF, therefore the smallest recommended size needle for diagnostic and therapeutic LPs is 22G. […] 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: Bed rest of any duration after LP does not decrease the incidence of post LP headache. […] Conclusion: Volume of CSF was not a risk factor for post LP headache.

• #13 Spinal Headache

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

  Use a small gauge spinal needle (20 to 22) for Lumbar Puncture (LP) […] Use non-Traumatic, blunt, non-cutting needle for Lumbar Puncture […] Insert LP needle bevel parallel to dural fibers […] Replace the spinal needle stylet before removal […] Minimize number of Lumbar Puncture attempts […] Patients should avoid straining, bending or heavy lifting after Lumbar Puncture […] Intravenous Fluids prior to Lumbar Puncture does not decrease Spinal Headache Incidence but may decrease duration […] Bedrest for at least 1 hour following Lumbar Puncture does not appear to affect postdural headache Incidence.

• #14 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38361721/

  Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. […] Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.

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

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

  Conclusion: The position that LP is performed does not make a difference in post LP headache. […] Conclusion: IVF prior to LP does not decrease incidence of post LP headache, but may decrease duration of headache 24 hours. […] Conclusion: Oral hydration post LP does not appear to decrease incidence of post LP headache. […] Conclusion: IV caffeine 500mg provides a temporary improvement in symptoms for post LP headache. […] Conclusion: A blood patch of at least 10 30mL is quite effective in treating post LP headaches. […] What Helps Prevent Post LP Headaches: 20 22G needles seems to be the optimal size for diagnostic/therapeutic LPs in adults, Needle bevel parallel to dural fibers, Replacement of stylet before withdrawal of spinal needle, Early ambulation, NOT laying flat post procedure, Number of LP attempts (Never studied, but pathophysiologically makes sense). […] What DOES NOT Help Prevent Post LP Headaches: Volume of CSF removed, Patient Position, IVF prior to LP, but may decrease duration of headache being 24 hours.

• #16 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Neither bed rest nor hyper hydration were found to be protective against PDPH in a systematic review and meta-analysis. […] Several prophylactic drugs have been studied, but their clinical effectiveness has not been established and various regimens used have been associated with adverse events. […] A review of drug therapy for preventing PDPH that including 10 RCTs reports that reduction in the incidence of PDPH was seen with epidurally administered morphine (RR=0.25), intravenous cosyntropin (RR 0.49), and intravenous aminophylline (RR 0.21 at 48 hours). […] Theoretically leaving an intrathecal catheter in the dural puncture hole up to 24 h can prevent PDPH by initiate local inflammation, seal the hole, encourages hole closure and prevents CSF leakage. […] A prophylactic epidural blood patch involves the injection of autologous blood through the epidural catheter (usually 20 mL) before removal of the catheter.

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

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

  Needle size must however be large enough to withdraw fluid safely, efficiently, and measure accurate opening pressures. Spinal needles 22G may give false opening pressure readings and take as long as 6 minutes to withdraw 2mL of CSF, therefore the smallest recommended size needle for diagnostic and therapeutic LPs is 22G. […] 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: Bed rest of any duration after LP does not decrease the incidence of post LP headache. […] Conclusion: Volume of CSF was not a risk factor for post LP headache.

• #18 Spinal Headache

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

  Use a small gauge spinal needle (20 to 22) for Lumbar Puncture (LP) […] Use non-Traumatic, blunt, non-cutting needle for Lumbar Puncture […] Insert LP needle bevel parallel to dural fibers […] Replace the spinal needle stylet before removal […] Minimize number of Lumbar Puncture attempts […] Patients should avoid straining, bending or heavy lifting after Lumbar Puncture […] Intravenous Fluids prior to Lumbar Puncture does not decrease Spinal Headache Incidence but may decrease duration […] Bedrest for at least 1 hour following Lumbar Puncture does not appear to affect postdural headache Incidence.

• #19 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #20 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38361721/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable.

• #21

  https://journals.lww.com/jwas/fulltext/2022/12040/the_effect_of_sumatriptan,_theophylline,.16.aspx

  Among the treatments, caffeine is a safe and effective option in the management of PDPH. […] Oral and intravenous theophylline can be effectively treated PDPH, which inhibit the enzyme phosphodiesterase and increase the concentrations of cellular CAMP and antagonistic effects of adenosine receptors. […] Pregabalin, is a anticonvulsant drug that prevents calcium from entering the body, therefore preventing headaches. […] Sumatriptan, as a serotonin receptor agonist, effectively relieves migraines and cluster-type headaches. […] This systematic review investigated the effects of oral caffeine, sumatriptan, theophylline, and pregabalin on preventing post-SA headaches. […] According to the studies, two mechanisms have been suggested as the causes of PDPH. One of the mechanisms is rupture of the dura mater membrane and loss of cerebrospinal fluid and stretching of pain-sensitive structures inside the skull.

• #22 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Neither bed rest nor hyper hydration were found to be protective against PDPH in a systematic review and meta-analysis. […] Several prophylactic drugs have been studied, but their clinical effectiveness has not been established and various regimens used have been associated with adverse events. […] A review of drug therapy for preventing PDPH that including 10 RCTs reports that reduction in the incidence of PDPH was seen with epidurally administered morphine (RR=0.25), intravenous cosyntropin (RR 0.49), and intravenous aminophylline (RR 0.21 at 48 hours). […] Theoretically leaving an intrathecal catheter in the dural puncture hole up to 24 h can prevent PDPH by initiate local inflammation, seal the hole, encourages hole closure and prevents CSF leakage. […] A prophylactic epidural blood patch involves the injection of autologous blood through the epidural catheter (usually 20 mL) before removal of the catheter.

• #23 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #24 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #25 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #26 The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial

  https://ijms.sums.ac.ir/article_50162.html

  Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. […] Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). […] Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section. […] The present study investigated the prophylactic effect of this combination among obstetrics. Patients were given acetaminophen and caffeine before receiving spinal anesthesia. It was found that women who received prophylactic medication were 70% less likely to develop PDPH.

• #27 The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial

  https://ijms.sums.ac.ir/article_50162.html

  The findings of the present study indicated that prophylactic administration of 500 mg acetaminophen and 65 mg caffeine compound to parturients undergoing spinal anesthesia for cesarean section decreased the chance of development of PDPH by 70%. Participants who received prophylactic medication also reported milder headaches and higher levels of satisfaction with their postpartum experience 72 hours after the procedure.

• #28 Evaluation of the Effects of Oral Magnesium Sachet on the Prevention of Spinal Anesthesia-Induced Headache After Cesarean Section: A Randomized Clinical Trial

  https://brieflands.com/articles/aapm-121834

  Post-dural puncture headache (PDPH) is a common complication of spinal anesthesia. […] This study aimed to evaluate the effect of oral magnesium on the prevention of PDPH after cesarean section for the first time. […] In women candidates for cesarean section, oral administration of 300 mg magnesium 2 hours before surgery significantly reduces the frequency and severity of PDPH, but its impact on reducing analgesic consumption is not significant. […] The efficacy of magnesium as an antimigraine and analgesic adjuvant has been proven, but its benefit in prophylaxis or treatment of PDPH has not yet been evaluated. […] According to our findings, the use of 300 mg of oral magnesium sachet 2 hours before performing spinal anesthesia in elective cesarean section markedly decreased the incidence and severity of PDPH, but its impact on reducing analgesic consumption was not significant.

• #29 Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05531-7

  Post-dural puncture headache (PDPH) is a major complication of neuraxial anesthesia. PDPH usually occurs after Caesarean section in obstetric patients. The efficacy of prophylactic pharmacological therapies remains controversial. […] Several pharmacological therapies for preventing PDPH have been developed in parturients, including aminophylline (AMP), dexamethasone (DXM), gabapentin/pregabalin (GBP/PGB), hydrocortisone (HCT), magnesium (Mg), ondansetron (OND), and propofol (PPF). […] Based on available data, PPF, OND, and AMP may have better efficacy in decreasing the incidence of PDPH compared to the placebo group. […] The results of this study revealed that DXM and HCT, as the two most common glucocorticoids, were unable to reduce the incidence and severity of PDPH in parturients, which was consistent with the recent meta-analysis. […] Based on available data, PPF, OND, and AMP may have better efficacy than other proposed treatments in decreasing the incidence of PDPH. No obvious side effects were revealed in the analyses or the involved studies. Better-designed RCTs are needed to validate the conclusions.

• #30 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. […] The treatment and prevention options for PDPH differ widely from one institution to another. […] The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. […] This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. […] Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. […] On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results.

• #31 Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05531-7

  Post-dural puncture headache (PDPH) is a major complication of neuraxial anesthesia. PDPH usually occurs after Caesarean section in obstetric patients. The efficacy of prophylactic pharmacological therapies remains controversial. […] Several pharmacological therapies for preventing PDPH have been developed in parturients, including aminophylline (AMP), dexamethasone (DXM), gabapentin/pregabalin (GBP/PGB), hydrocortisone (HCT), magnesium (Mg), ondansetron (OND), and propofol (PPF). […] Based on available data, PPF, OND, and AMP may have better efficacy in decreasing the incidence of PDPH compared to the placebo group. […] The results of this study revealed that DXM and HCT, as the two most common glucocorticoids, were unable to reduce the incidence and severity of PDPH in parturients, which was consistent with the recent meta-analysis. […] Based on available data, PPF, OND, and AMP may have better efficacy than other proposed treatments in decreasing the incidence of PDPH. No obvious side effects were revealed in the analyses or the involved studies. Better-designed RCTs are needed to validate the conclusions.

• #32 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  Neither bed rest nor hyper hydration were found to be protective against PDPH in a systematic review and meta-analysis. […] Several prophylactic drugs have been studied, but their clinical effectiveness has not been established and various regimens used have been associated with adverse events. […] A review of drug therapy for preventing PDPH that including 10 RCTs reports that reduction in the incidence of PDPH was seen with epidurally administered morphine (RR=0.25), intravenous cosyntropin (RR 0.49), and intravenous aminophylline (RR 0.21 at 48 hours). […] Theoretically leaving an intrathecal catheter in the dural puncture hole up to 24 h can prevent PDPH by initiate local inflammation, seal the hole, encourages hole closure and prevents CSF leakage. […] A prophylactic epidural blood patch involves the injection of autologous blood through the epidural catheter (usually 20 mL) before removal of the catheter.

• #33 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  It should be done after full recovery of sensation (at least 5 h after the last dose of epidural anesthetic) to prevent the inhibition of coagulation by LA or accidental total spinal anesthesia. […] A systematic review and meta-analysis of 9 studies (4 for prophylactic and 5 for therapeutic) reported that routine prophylactic epidural blood patch is not recommended because there are too few trial participants to allow reliable conclusions. […] It is believed that injecting saline into the epidural space may increase epidural pressure and decrease CSF loss or induce an inflammatory reaction and promoting closure of the dural perforation.

• #34 Prevention and Management of Post- Dura Puncture Headache (PDPH)

  http://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.php?jid=ijaa

  It should be done after full recovery of sensation (at least 5 h after the last dose of epidural anesthetic) to prevent the inhibition of coagulation by LA or accidental total spinal anesthesia. […] A systematic review and meta-analysis of 9 studies (4 for prophylactic and 5 for therapeutic) reported that routine prophylactic epidural blood patch is not recommended because there are too few trial participants to allow reliable conclusions. […] It is believed that injecting saline into the epidural space may increase epidural pressure and decrease CSF loss or induce an inflammatory reaction and promoting closure of the dural perforation.

• #35 Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10867709/

  Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. […] Smaller non-cutting needles play a role in avoiding PDPH. […] Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. […] Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. […] This study highlights the need for larger research to define the best approach to prevent and treat PDPH.

• #36 Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/124339-post-dural-puncture-headache-after-spinal-cord-stimulator-lead-insertion-successfully-treated-with-occipital-nerve-blocks

  Post-dural puncture headache (PDPH) is a common and debilitating complication that can arise after spinal or epidural anesthesia, or following the placement of spinal cord stimulation leads due to inadvertent dural puncture. […] Treatment options for PDPH may include a trial of conservative management, such as increased fluid intake and hydration, caffeine, and oral analgesics. If conservative options fail to alleviate symptoms, an epidural blood patch (EBP) is commonly performed. […] In recent years, peripheral nerve blocks, particularly occipital nerve blocks, have gained attention as a viable alternative or adjunctive treatment for PDPH. […] The goal of occipital nerve blocks is to block the transmission of pain signals from the occipital nerves, thereby reducing pain and discomfort.

• #37 Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/124339-post-dural-puncture-headache-after-spinal-cord-stimulator-lead-insertion-successfully-treated-with-occipital-nerve-blocks

  Occipital nerve blocks have emerged as a promising treatment modality for patients suffering from PDPH, particularly in cases where conventional therapies like EBP are not able to be performed or have failed. […] The success of occipital nerve blocks in this case aligns with the literature. However, it is important to note that while the procedure is generally safe, it is not without risks, such as infection, bleeding, or nerve injury, although these complications are rare. […] Moreover, the long-term efficacy of occipital nerve blocks for PDPH remains an area requiring further research. Current evidence primarily supports their short-term benefits, and more studies are needed to evaluate their role in the sustained management of PDPH. […] This case report illustrates the potential of occipital nerve blocks as an effective treatment for PDPH, particularly in cases where conventional therapies like epidural blood patches fail.

• #38 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  A spinal headache is triggered when fluid leaks from your spine. The leakage decreases the fluid pressure around your brain, causing it to sag downward. When the brain sags, it stretches the surrounding nerves, creating intense head pain. […] How can I prevent getting a spinal headache? When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Chiropractic care is essential for headache prevention since spinal misalignment and spinal fluid levels contribute to headaches. Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #39 Headache Relief – Uintah Spinal Health

  https://www.uintahspinalhealth.com/headache-relief/

  Prevention: Improve your workspace ergonomics and posture to prevent future tension buildup. […] Treatment: Regular chiropractic adjustments combined with specific neck and spine exercises are effective for long-term management.

• #40 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  A spinal headache is triggered when fluid leaks from your spine. The leakage decreases the fluid pressure around your brain, causing it to sag downward. When the brain sags, it stretches the surrounding nerves, creating intense head pain. […] How can I prevent getting a spinal headache? When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Chiropractic care is essential for headache prevention since spinal misalignment and spinal fluid levels contribute to headaches. Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #41 The Importance of Proper Spinal Alignment in Headache Prevention and Treatment | Atlas Chiropractic | Boulder

  https://alisonbremner.com/headaches/the-importance-of-proper-spinal-alignment-in-headache-prevention-and-treatment/

  At Atlas Chiropractic, serving the communities of Boulder, Superior, and Erie, we understand the profound impact that spinal alignment can have on headache prevention and treatment. […] By addressing spinal misalignments, chiropractic care aims to restore proper nervous system function, thereby alleviating headache symptoms at their root. […] Chiropractic adjustments help release this tension, promoting relaxation and alleviating headache discomfort. […] Proper spinal alignment ensures that the nervous system operates efficiently, reducing the likelihood of neurological disturbances that can trigger headaches. […] Unlike symptomatic treatments that merely mask pain, chiropractic care targets the underlying causes of headaches by addressing spinal misalignments and promoting long-term wellness.

• #42 The Importance of Proper Spinal Alignment in Headache Prevention and Treatment | Atlas Chiropractic | Boulder

  https://alisonbremner.com/headaches/the-importance-of-proper-spinal-alignment-in-headache-prevention-and-treatment/

  We believe that by addressing the root cause of headaches and promoting spinal alignment, individuals can experience lasting relief and reclaim control over their lives. […] By embracing the principles of chiropractic care and prioritizing spinal health, individuals can embark on a journey towards holistic wellness and vitality.

• #43

  https://www.hutterchiro.com/doctor/chiropractor/chiropractic-Groton/nutrition-articles/migraine-headache-help-prevention-diet-vitamin-d-and-spinal-manipulation

  A healthy diet feeds the body and the mind. Researchers have noticed that migraine triggers appear in many different forms – environmental, hormonal, and dietary. A high-quality diet effectively helps manage migraine. […] A very low-calorie ketogenic diet was found to be preventive of episodic migraines. Usefulness was noted within one month of the diet modification. […] The anti-inflammatory and antioxidant features of vitamin D have opened its supplementation to considered inclusion in the care and prevention of headache and migraine. […] In particular, spinal manipulation, chiropractic care, some supplements, diet change and hydrotherapy are reported helpful for migraine headache. […] Shoreline Medical Services/ Hutter Chiropractic Office welcomes headache and/or migraine sufferers for preventive and alleviating care like diet modification, supplementation, and Groton chiropractic spinal manipulation. […] Shoreline Medical Services/ Hutter Chiropractic Office offers relieving treatment and helpful tips for prevention of headache and migraine.

• #44

  https://www.satterwhitechiropractic.com/doctor/chiropractor/chiropractic-Oxford/nutrition-articles/migraine-headache-help-prevention-diet-vitamin-d-and-spinal-manipulation

  A healthy diet feeds the body and the mind. Researchers have discussed that migraine triggers come in many different forms – environmental, hormonal, and dietary. A high-quality diet successfully helps control migraine. […] A very low-calorie ketogenic diet was revealed to be preventive of episodic migraines. Usefulness was noted within one month of the diet modification. […] Vitamin D deficiency has been found in 45% to 100% of migraine sufferers. The anti-inflammatory and antioxidant features of vitamin D have opened its supplementation to considered inclusion in the care and prevention of headache and migraine. […] In particular, spinal manipulation, chiropractic care, some supplements, diet change and hydrotherapy are reported beneficial for migraine headache. […] Satterwhite Chiropractic welcomes headache and/or migraine sufferers for preventive and alleviating approaches like diet modification, supplementation, and Oxford chiropractic spinal manipulation. […] Satterwhite Chiropractic offers relieving treatment and beneficial tips for prevention of headache and migraine.

• #45 Spinal Cord Stimulator Implants for Chronic Headaches | Spinal Stimulation Experts

  https://myspinalstimulator.com/spinal-cord-stimulator-implants-for-chronic-migraine-headaches/

  Spinal cord stimulation provides a more potent way to manage chronic headaches unresponsive to conventional treatments. The International Headache Society has also attested the relevancy of neuromodulation for long-term management of incessant, chronic daily headaches and prevention of associated disability. […] Spinal cord stimulation reduces occurrence of neuralgia-linked headaches by 90%. […] About 65% improvements in chronic migraine and other types of headaches a year after SCS implant. (Neurostimulation, 2011) […] At least 71% migraine patients have more than 50% pain relief (average 60%) and over 37% gave up painkillers. (Neuromodulation, 2015) […] SCS therapy was found to be beneficial for those with cluster headaches. (Current Painand Headache Reports, 2013) […] Spinal cord stimulation interrupts pain signal transmission to ensure that pain is not perceived by the brain. It does not eliminate the cause of pain.

• #46 Spinal Cord Stimulator Implants for Chronic Headaches | Spinal Stimulation Experts

  https://myspinalstimulator.com/spinal-cord-stimulator-implants-for-chronic-migraine-headaches/

  People suffering chronic daily headaches can consider spinal cord stimulator implant if they have persistent headaches, chronic headaches not relieved by any other treatment, no painkiller dependency, SCS trial succeeds in providing pain relief from chronic headache, and no serious neurological deficit. […] If trial test provides more than 50% pain relief from chronic headache during the 7-day assessment, it is considered a success and patient is suggested for a permanent spinal cord stimulator implant. […] Spinal cord stimulator implant to manage chronic headaches requires about 1 to 2 hours. […] It is an outpatient procedure and patients are discharged after a brief monitoring. […] Once implanted, spinal cord stimulator remains in the body for the rest of the life unless removed. There is no need to replace it. You just need to replace its batteries in every 5 to 10 years depending on the usage.

• #47 Spinal Cord Stimulator Implants for Chronic Headaches | Spinal Stimulation Experts

  https://myspinalstimulator.com/spinal-cord-stimulator-implants-for-chronic-migraine-headaches/

  People suffering chronic daily headaches can consider spinal cord stimulator implant if they have persistent headaches, chronic headaches not relieved by any other treatment, no painkiller dependency, SCS trial succeeds in providing pain relief from chronic headache, and no serious neurological deficit. […] If trial test provides more than 50% pain relief from chronic headache during the 7-day assessment, it is considered a success and patient is suggested for a permanent spinal cord stimulator implant. […] Spinal cord stimulator implant to manage chronic headaches requires about 1 to 2 hours. […] It is an outpatient procedure and patients are discharged after a brief monitoring. […] Once implanted, spinal cord stimulator remains in the body for the rest of the life unless removed. There is no need to replace it. You just need to replace its batteries in every 5 to 10 years depending on the usage.

• #48 Preventing Post-Dural Puncture Headaches: Clinical Best Practices – Rivanna Medical

  https://rivannamedical.com/preventing-post-dural-puncture-headaches-clinical-best-practices/

  Effective PDPH prevention hinges on getting the procedure right the first time. This involves not just selecting the correct needle but adopting evidence-based protocols, standardized practices, ongoing clinician training, and ultrasound imaging guidance. […] Needle selection: Pencil-point spinal needles consistently demonstrate lower PDPH rates than cutting-tip alternatives. Their design spreads dural fibers rather than cutting them, promoting better closure and less CSF leakage. […] Protocol standardization: Hospitals that implement structured, protocol-driven neuraxial anesthesia programs especially those standardizing the use of pencil-point needles and simulation-based training have demonstrated statistically significant reductions in PDPH rates. […] Combining proven techniques with accessible, neuraxial-specific tools positions us for greater success in both preventing PDPH and optimizing the overall patient experience.

• #49 Preventing Post-Dural Puncture Headaches: Clinical Best Practices – Rivanna Medical

  https://rivannamedical.com/preventing-post-dural-puncture-headaches-clinical-best-practices/

  The anesthesiology community has made significant strides in PDPH prevention, yet ongoing advancements in technology and clinical protocols continue to shape best practices. From optimizing procedural techniques to leveraging AI and ultrasound for enhanced precision, the future of neuraxial anesthesia is evolving toward lower PDPH incidence and improved patient recovery.

• #50 Preventing Post-Dural Puncture Headaches: Clinical Best Practices – Rivanna Medical

  https://rivannamedical.com/preventing-post-dural-puncture-headaches-clinical-best-practices/

  The anesthesiology community has made significant strides in PDPH prevention, yet ongoing advancements in technology and clinical protocols continue to shape best practices. From optimizing procedural techniques to leveraging AI and ultrasound for enhanced precision, the future of neuraxial anesthesia is evolving toward lower PDPH incidence and improved patient recovery.

• #51 Preventing Post-Dural Puncture Headaches: Clinical Best Practices – Rivanna Medical

  https://rivannamedical.com/preventing-post-dural-puncture-headaches-clinical-best-practices/

  Effective PDPH prevention hinges on getting the procedure right the first time. This involves not just selecting the correct needle but adopting evidence-based protocols, standardized practices, ongoing clinician training, and ultrasound imaging guidance. […] Needle selection: Pencil-point spinal needles consistently demonstrate lower PDPH rates than cutting-tip alternatives. Their design spreads dural fibers rather than cutting them, promoting better closure and less CSF leakage. […] Protocol standardization: Hospitals that implement structured, protocol-driven neuraxial anesthesia programs especially those standardizing the use of pencil-point needles and simulation-based training have demonstrated statistically significant reductions in PDPH rates. […] Combining proven techniques with accessible, neuraxial-specific tools positions us for greater success in both preventing PDPH and optimizing the overall patient experience.

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