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Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. When performing lumbar puncture, use of noncutting spinal needles decreases risk of postdural puncture headache. If cutting needles are used, insertion with the bevel parallel to the long axis of Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. Theophylline has also been shown to increase the proportion of participants that report an improvement in pain scores when compared with conventional treatment. In some studies, gabapentin has been shown to decrease the incidence and severity of PDPH and opioid consumption without significant adverse effects. A 22-year-old female presented with an intractable headache after a recent lumbar puncture (LP). Postdural puncture headache (PDPH) is a potential expected complication of a lumbar puncture, with symptoms related to traction on pain-sensitive structures from low cerebrospinal fluid (CSF) pressure (intracranial hypotension) following a leak of CSF at the puncture site.[1][2][3] Post‐dural puncture headache (PDPH) is the most common complication of a lumbar puncture. The symptoms are a constant headache that worsens in the upright position and improves when lying down and resolves spontaneously within five to seven days. First, brain imaging may be considered when nonorthostatic headache is present or develops after initial orthostatic headache or when headache onset is more than 5 days after suspected dural puncture (evidence grade: C; level of certainty: low). Post-dural puncture headache (PDPH) is a vexing problem of the patients following spinal anesthesia or a complication relative to inadvertent dural puncture in epidural anesthesia. The prevention and management of PDPH contain a laddered forestallment and therapy with varying results. The anticonvul nine patients we observed an excellent result with reduction of headache severity within 24 hours. Gabapentin appears potentially beneficial in the management of patients with post-dural puncture headaches. Key Words: gabapentin, post-dural puncture headache Anaesth Intensive Care 2012; 40: 714-718 Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. In this study, we aimed to investigate the effect of pregabalin on post-dural-puncture headache (PDPH). Forty patients who developed PDPH after spinal anesthesia or diagnostic and/or therapeutic lumbar puncture were divided into two groups and followed for 5 days. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4:595–602. [PMC free article] [Google Scholar] 26. Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post-lumbar puncture headaches: experience in 501 consecutive procedures. 9. Strupp M, Brandt T, Muller A. Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol. 1998;245(9):589-592. 10. Ona XB, Osorio D, Cosp XB. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;7:CD007887. doi:10.1002/14651858 *Criteria for PDPH based on the International Headache Society criteria Discharge 2 Conservative treatment: • Acetaminophen x3 days then PRN • Ibuprofen x3 days then PRN • Gabapentin x3 days • Continue PO hydration Epidural blood patch: • Acetaminophen PRN • Ibuprofen PRN • Continue PO hydration • Follow up phone call post- The medical evidence behind specific medications and techniques will be discussed below: Post-dural Puncture Headache (PDPH) PDPHs are low-pressure headaches attributed to the loss of cerebrospinal fluid (CSF) after a dural puncture. The International Headache Society (IHS) defines PDPH as a headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid (CSF) leakage through the dural puncture. It is usually accompanied by neck stiffness and/or subjective hearing symptoms. Definition and incidence – Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache may occur after diagnostic or therapeutic LP, spinal anesthesia, or unintentional dural puncture (UDP) during epidural anesthesia. PDPH is caused by leakage of cerebrospinal fluid through the dural hole created by the needle. Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Higher risk of developing post-LP headache if larger diameter needle or cutting needle used & higher incidence with repeated LP attempts (repeat dura punctures) So use a small-diameter, blunt needle to help prevent post-LP headache; Bevel should be parallel to the longitudinal dural fibers; Replace stylet prior to removing the needle Myth: fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache. West J Med. 2002 Jan;176(1):69-70. PMID: 11788546. Ahmed SV et al. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006 Nov; 82(973): 713–716. PMID: 17099089. Swanson JW. Post-lumbar puncture
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