PDPHs
Post-dural puncture headache (PDPH) refers to a self-limited headache that develops after dural puncture, most commonly following lumbar puncture or spinal anesthesia. The pathophysiology involves leakage of cerebrospinal fluid through the puncture site, leading to intracranial hypotension and downward sagging of the brain. The resultant traction on pain-sensitive structures causes a predominantly positional headache.
Clinical features include onset within hours to days after the puncture, a throbbing or dull head pain
Diagnosis is clinical; imaging is not routinely required but MRI can show pachymeningeal enhancement and brain
Prevention focuses on technique. Using atraumatic (non-cutting) needles, smaller gauge, and minimizing dural puncture attempts reduces
Treatment includes supportive measures—hydration, analgesics, and caffeine—though evidence is limited. For persistent or severe PDPH, an
Prognosis is generally favorable; most PDPHs resolve completely. Complications are rare but can include subdural hematomas,