[Post-dural puncture headache]

Abstract

Post dural puncture headache is one of the major complications of spinal anaesthesia. In order to establish this diagnosis, the headache must be dependent on the position of the patient. The symptoms are probably due to leakage of cerebro-spinal fluid from the subarachnoid space to the epidural space which results in intracranial hypotension and tension of the nociceptive intracranial structures. The incidence is highest in young patients and the complication is observed more frequently in women than in men. In all age groups, the frequency and severity of the condition depend upon the calibre of the puncture needle and, for this reason, the finest possible needle should be employed. The only well proved prophylactic and curative treatment consists of establishing an epidural blood-patch. This procedure should be considered as the primary method of treatment in patients in whom post dural puncture headache contributes to prolongation of the period of convalescence.