postduralpunktionhuvudvärk

Postdural puncture refers to symptoms that arise after a breach of the dura mater, most commonly following a lumbar puncture or neuraxial anesthesia. The most recognizable manifestation is a postdural puncture headache, which typically begins within 24 to 72 hours and usually resolves within days to a week, though some cases last longer.

The underlying cause is a persistent cerebrospinal fluid (CSF) leak that lowers intracranial pressure. This loss of CSF can cause brain sag and traction on pain-sensitive structures, producing headache and other symptoms. Rare complications include subdural hematoma and intracranial hypotension syndrome.

Clinical features are dominated by a positional headache that worsens when standing or sitting and improves when lying down. Associated symptoms may include neck stiffness, nausea, photophobia, tinnitus, or dizziness. Diagnosis is largely clinical; imaging, typically MRI, is reserved for atypical features, persistent or worsening symptoms, or to exclude other pathology.

Management starts with supportive measures such as bed rest (though evidence for strict restriction is limited), adequate hydration, analgesics, and caffeine or other symptomatic therapies. If symptoms persist or are severe, an epidural blood patch is the most effective treatment, involving the injection of a patient’s own blood into the epidural space to seal the dural leak. Other options include epidural saline injections or, less commonly, sphenopalatine ganglion blocks.

Prevention focuses on technique and equipment: using atraumatic (pencil-point) needles, minimizing puncture attempts and needle size, and ensuring experienced practitioners perform neuraxial procedures. Most patients recover fully, though persistent or recurrent symptoms may require repeat intervention.