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Area of Science:

  • Neurology
  • Pharmacology
  • Anesthesiology

Background:

  • Post-dural puncture headache (PDPH) is a common complication following lumbar puncture.
  • Existing drug therapies for PDPH have varying degrees of uncertainty regarding their effectiveness.

Purpose of the Study:

  • To evaluate the efficacy and safety of pharmacological interventions for treating PDPH in adult and pediatric populations.
  • To synthesize evidence from randomized controlled trials (RCTs) on drug therapy for PDPH.

Main Methods:

  • Systematic review of RCTs identified through comprehensive database searches (CENTRAL, MEDLINE, EMBASE, CINAHL).
  • Inclusion of studies assessing pharmacological drugs for PDPH, with outcomes including headache persistence, pain severity, and adverse events.
  • Data extraction and risk of bias assessment by independent reviewers; intention-to-treat analysis performed.

Main Results:

  • Caffeine demonstrated effectiveness in reducing PDPH persistence and the need for supplementary treatments compared to placebo.
  • Gabapentin, hydrocortisone, and theophylline showed improvements in pain severity scores.
  • Sumatriptan, adrenocorticotropic hormone (ACTH), pregabalin, and cosyntropin lacked conclusive evidence of efficacy.

Conclusions:

  • Caffeine is an effective treatment for PDPH.
  • Gabapentin, hydrocortisone, and theophylline show potential for pain reduction in PDPH.
  • Further research is needed due to small study sizes and limited generalizability, cautioning interpretation of results.