Postdural puncture headache: Revisited

Postdural puncture headache (PDPH) may develop after an unintended (accidental) dural puncture, after deliberate dural puncture for spinal anaesthesia or during diagnostic dural punctures performed by other medical specialties. PDPH may sometimes be predictable (patient characteristics, inexperienced operator or co-morbidities), is almost never immediately evident during the procedure, and sometimes presents late, after discharge. Specifically, PDPH severely restricts activities of daily living, patients may be bedridden for several days and mothers may have difficulty in breastfeeding. Although an epidural blood patch (EBP) remains the management technique with greatest immediate success, most headaches resolve over time but may cause mild-severe disability. Failure of EBP after the first attempt is not uncommon, and major complications may occur but are rare. In the current review of the literature, we discuss the pathophysiology, diagnosis, prevention and management of PDPH following accidental or intended dural puncture, and present possible therapeutic options for the future.