User:Mr. Ibrahem/Post-dural-puncture headache

Post-dural-puncture headache (PDPH), also known as  spinal headache, is a complication of puncture of the dura mater, one of the membranes around the brain and spinal cord. Symptoms generally include a severe headache, which is worsened by standing and relieved to some degree by lying down. Other symptoms may include neck stiffness, nausea, limb pain, hearing loss, ringing in the ears, world spinning, and numbness of the scalp. Complications may include cranial nerve problems, subdural hematoma, and cerebral venous sinus thrombosis.

The most common cause is as a side effect of a lumbar puncture, including spinal anesthesia and during epidural catheter placement. Risk factors include history of prior headaches and low BMI. It generally occurs within five days; however, is rarely of immediate onset. The underlying mechanism involves leakage of cerebrospinal fluid (CSF) resulting in reduced fluid levels around the brain. Diagnosis is generally based on symptoms, with brain imaging if this is unclear.

Using a non-cutting (pencil point) rather than a cutting spinal needle decreases the risk; however the size of the non-cutting needle does not appear to make a difference. If using a cutting needle, a smaller rather then larger size is also associated with less risk. Bed rest after the procedure has not been found to be useful. Treatment may involve a greater occipital nerve block or epidural blood patch; though, without treatment symptoms often resolve within 2 weeks. Pain may be managed with acetaminophen, NSAIDs, and caffeine; if these are not effective opioids for a short period.

Post-dural-puncture headache is estimated to occur in less than 2% to 40% of procedures. It occurs most frequently in those who are 20 to 40 years old. Females are more commonly affected than males. The condition was first described in 1899 by August Bier. The epidural blood patch came into use in 1960.