Successful spinal anaesthesia for caesarean birth after epidural blood patch for intracranial hypotension headache

Headache in pregnancy remains a diagnostic challenge. Neuraxial intervention in the antenatal period can lead to complications, such as postdural puncture headache and subdural haematoma, and may have a significant impact on maternal well-being, labour and birth. Here, we describe a case of headache secondary to intracranial hypotension with onset at 32 weeks of gestation in a 40-year-old woman, 12 weeks following spinal anaesthesia for cervical cerclage. It presented novel problems to consider for the performance of lumbar epidural blood patch and the subsequent neuraxial anaesthesia for the birth. A lumbar epidural blood patch was performed at 38⁺¹ weeks of gestation with full resolution of symptoms, and spinal anaesthesia was subsequently provided the following day for a caesarean birth with good efficacy and no adverse effects. We demonstrated that the low cerebrospinal fluid pressure headache can be effectively and safely managed with a lumbar epidural blood patch, and spinal anaesthesia for caesarean birth may be successfully performed within 24 h of the lumbar epidural blood patch.