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  • Print publication year: 2008
  • Online publication date: December 2009

Postdural puncture headache

from Chief complaints and diagnoses


The diagnosis of neuropathic pain (NP) encompasses a broad array of conditions. For the acute care provider, the goals of NP therapy are to decrease persistent pain and suppress breakthrough pain. One recommended strategy for NP treatment is to begin the therapy simultaneously with two drugs: an analgesic (e.g. mild opioid) and an adjuvant (e.g. antidepressant). Opioid doses in NP may be relatively higher than customary for non-NP indications, and in fact varying types of NP may warrant different opioid dosages. Clinically, patients with allodynia are potential candidates for local anesthetic use. Local anesthetics may also be useful in NP when administered in the form of regional nerve blocks. Since inflammatory mediators sensitize nociception, the anti-inflammatory corticosteroids have been used for NP. Corticosteroids also decrease local edema, thus reducing pressure on peripheral nerves. As dexamethasone has relative few mineralocorticoid effects, it is preferred by many who use corticosteroids in NP.


1. Thoennissen J, Herkner H, Lang W, et al. Does bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis. CMAJ. 2001;165(10):1311–1316.
2. Imarengiaye C, Ekwere I. Postdural puncture headache: a cross-sectional study of incidence and severity in a new obstetric anaesthesia unit. Afr J Med Sci. 2006;35(1):47–51.
3. Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990;70(2):181–184.
4. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718–729.
5. Lin YT, Sheen MJ, Huang ST, et al. Gabapentin relieves post-dural puncture headache: a report of two cases. Acta Anaesthesiol Taiwan. 2007;45(1):47–51.
6. Ghai A, Wadhera R. Adrenocorticotrophic hormone: is a single dose sufficient for post-dural puncture headache? Acta Anaesthesiol Scand. 2007;51(2):266.
7. Kshatri AM, Foster PA. Adrenocorticotropic hormone infusion as a novel treatment for postdural puncture headache. Reg Anesth. 1997;22(5):432–434.
8. Choi A, Laurito CE, Cunningham FE. Pharmacologic management of postdural puncture headache. Ann Pharmacother. 1996;30(7–8):831–839.
9. Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol. 2006;19(3):249–253.
10. Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg. 2005;56(3):265–269.
11. Safa-Tisseront V, Thormann F, Malassine P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95(2):334–339.