Postdural puncture headache: a literature review

This is a review of literature from 1943 to mid-1989 on the postdural puncture headache. The article looks at the currently held thoughts on the cause, prevention, and treatments of this second most frequent side effect of spinal anesthesia. Postdural puncture headache (PDPH) is caused by vascular distension within the nondistensible cranium following the leakage of cerebral spinal fluid (CSF) into the epidural space. Prevention of PDPH can be accomplished by using small-gauge needles and possibly by using the lateral approach, as opposed to the midline approach. Luck plays a big part, because if the needle punctures a thicker portion of the dura, there is a reduced chance of PDPH. Epidural saline injection is effective only if it is used as a continuous infusion for 24 hours. The usefulness of caffeine sodium benzoate with a 70-80% success rate and epidural blood patching with a 90%-plus success rate are discussed.