A postdural puncture headache (PDPH) is a type of headache that can occur after a spinal or lumbar puncture due to the leakage of cerebrospinal fluid (CSF). CSF leakage occurs after the dura, a strong membrane that surrounds the spinal cord and brain is punctured. This can happen when a needle is inserted into the spine for a variety of reasons, including during a lumbar puncture (also called a spinal tap) or epidural.
As a result of the hole made in the dura mater (the outermost layer of the meninges) not being properly sealed, a leakage happens. The loss of CSF can result in a decrease in the pressure around the brain, causing the individual to experience a headache. It worsens in an upright position and improves with lying down. It is a self-limited condition that typically resolves itself within a few days, however, in some cases, it can last for weeks or even months. Some people may experience persistent or recurrent headaches.
Symptoms, Risk Factors, Complications
A PDPH typically presents with a dull headache that gets worse when sitting or standing and is relieved by lying down. Other symptoms may include neck stiffness, nausea, and vomiting.
There are several risk factors for developing PDPH, including:
- Use of a small-gauge needle (19-22 gauge)
- Use of a beveled or cutting needle
- Use of a needle that is too long
- Inadequate CSF replacement after the puncture
- Excessive CSF loss after the puncture
- Female gender
- Younger age
There are several potential complications of PDPH, including:
- Persistent or recurrent headaches
- Cranial nerve palsies
- Cerebral edema
- Venous sinus thrombosis
Treatment of PDPH generally includes bed rest, hydration, and pain relief. If the headache is severe, a blood patch may be performed. This involves injecting a small amount of blood into the CSF space to seal the leak and stop the CSF from leaking out.
Postdural puncture headache should not be confused with spinal headache which is a type of headache that can occur after any type of spinal procedure, not just a lumbar puncture. It is different from post-lumbar puncture syndrome which is a general term that encompasses both PDPH and spinal headaches. A cerebrospinal fluid leak on the other hand is a leakage of CSF from the spinal cord or brain, which can occur without a lumbar puncture.
Lumbar puncture: A medical procedure in which a needle is inserted into the lower back to collect cerebrospinal fluid (CSF) for testing.
Spinal anesthesia: A type of anesthesia that numbs the lower half of the body by injecting medication into the spinal fluid.
Epidural anesthesia: A type of anesthesia that numbs the lower half of the body by injecting medication into the epidural space (the space around the spinal cord).
This image shows how often the term ‘Postdural Puncture Headache’ is used in relation to other, similar birth terms:
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