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Postdural puncture headache in obstetrics.

Wesley Edwards¹, Lorraine Chow^2,3, Valerie Zaphiratos^4,5

¹Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie

|July 22, 2025

Summary

Postdural puncture headache (PDPH) is a common complication in obstetric anesthesia. The most effective treatment for PDPH is an epidural blood patch, which should not be delayed in severe cases.

Keywords:

continuing professional development module epidural blood patch obstetric anesthesia postdural puncture headache review

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Published on: October 2, 2014

Area of Science:

Obstetrics and Gynecology
Anesthesiology
Neurology

Background:

Postdural puncture headache (PDPH) is a significant complication following neuraxial anesthesia in obstetric patients.
Risk factors include younger age and female sex, common demographics in the obstetric population.
PDPH can be incapacitating, impacting postpartum recovery and newborn care.

Purpose of the Study:

To review the literature on PDPH in obstetrics, covering pathophysiology, risk factors, diagnosis, and outcomes.
To explore evidence-based prevention and treatment strategies for PDPH in obstetric patients.
To emphasize the anesthesiologist's crucial role in managing PDPH.

Main Methods:

Literature review of postdural puncture headache in obstetrics.
Discussion of pathophysiology, risk factors, diagnosis, and outcomes.
Evidence-based exploration of prevention and treatment options.

Main Results:

PDPH is a headache developing after dural puncture, not attributable to other causes.
Younger age and female sex are risk factors; small-gauge, pencil-point needles reduce risk.
Epidural blood patch is the most effective treatment and should not be delayed for severe symptoms.

Conclusions:

PDPH significantly impacts postpartum individuals, often being incapacitating.
Epidural blood patch is the gold standard treatment for severe PDPH and should be administered promptly.
Anesthesia team assessment, treatment, and follow-up are essential until symptom resolution.