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Updated: May 9, 2026
05:40
Dural Stimulation and Periorbital von Frey Testing in Mice As a Preclinical Model of Headache
Published on: July 29, 2021
Post-dural Puncture Headache: Pathophysiology, Risk Stratification, Prevention, and Evidence-Based Management for
Rayees A Konduru1, Arshiya Shabnam2, Joel Yarmush1
1Anesthesiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA.
Cureus
|May 8, 2026
Summary
Post-dural puncture headache (PDPH) is a headache caused by cerebrospinal fluid (CSF) leakage after procedures like spinal anesthesia. Needle size and type significantly impact PDPH risk and management options.
Area of Science:
- Neurology
- Anesthesiology
- Neurosurgery
Background:
- Post-dural puncture headache (PDPH) is a secondary headache disorder caused by cerebrospinal fluid (CSF) leakage after dural puncture.
- It involves complex CSF hydrodynamics, intracranial hypotension, and meningeal irritation, leading to characteristic orthostatic headaches.
Purpose of the Study:
- To review the pathophysiology, risk factors, and management strategies for post-dural puncture headache.
- To highlight the role of procedural variables and emerging therapeutic approaches.
Main Methods:
- Review of existing literature on PDPH.
- Analysis of factors influencing PDPH incidence and outcomes.
- Discussion of current and emerging management strategies.
Main Results:
- PDPH incidence varies significantly based on needle characteristics (gauge, geometry) and procedure type, ranging from <3% with small atraumatic needles to 50-85% with large Tuohy needles.
- Epidural blood patch remains the gold-standard treatment with high success rates (70-90%).
Conclusions:
- Procedural factors are key modifiable determinants of PDPH risk.
- Future research into glymphatic dysfunction and neuroinflammation may improve PDPH risk stratification and treatment.
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