Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH)

Abstract

Background: Post-dural puncture headache (PDPH) is the most frequent complication of procedures associated with dural puncture for spinal anesthesia or following accidental dural puncture during epidural anesthesia. Since invasive treatments have known complications, pharmacologic management may be preferable. The aim of this study was to evaluate and compare the efficacy of theophylline and Acetaminophen in treatment of PDPH.

Methods: In this single-blind randomized clinical trial, 60 patients with Class I physical status according to ASA classification system, who suffered from PDPH were enrolled. Patients in Theophylline group were received theophylline tablet 250 mg three times per day, and in the other group acetaminophen 500 mg three times per day was administered. Pain intensity was assessed 2, 6, and 12 hour after drug administration using 0-10 cm Visual Analog Scale.

Results: The main VAS values is significantly lower in theophylline group in comparison with the acetaminophen group at 2 (5 +/- 1.57 vs. 5.97 +/- 1.27), 6 (3.43 +/- 1.73 vs. 4.33 +/- 1.49), and 12 (2.67 +/- 2.35 vs. 4.24 +/- 1.97) hours after drug administration (p < 0.05). No adverse effects were reported.

Discussion: Theophylline is a safe and effective treatment for PDPH. It may be tried in PDPH patients before using any invasive technique. Further investigations studying other Methylxanthines are recommended as well.