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Pharmacologic management of postdural puncture headache
A Choi1, C E Laurito, F E Cunningham
1Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago 60612, USA.
The Annals of Pharmacotherapy
|July 1, 1996
Summary
Oral and intravenous caffeine are effective, noninvasive treatments for postdural puncture headaches (PDPH). Epidural saline or dextran offer alternatives when the epidural blood patch is not feasible, though further research is needed for pharmacologic management.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Postdural puncture headache (PDPH) is a common complication following dural puncture.
- Understanding its pathogenesis, incidence, and clinical presentation is crucial for effective management.
Purpose of the Study:
- To comprehensively evaluate the pharmacologic management of PDPH.
- To discuss the pathogenesis, incidence, and clinical presentation of PDPH.
Main Methods:
- MEDLINE search for English literature, including reviews, case reports, letters, and abstracts.
- Inclusion of all clinical studies, case reports, abstracts, and letters due to limited literature on PDPH pharmacologic therapy.
- Extraction of information on pathophysiology, incidence, severity, and clinical presentation from research articles, reviews, and textbooks.
Main Results:
- The epidural blood patch (EBP) is highly effective, but pharmacologic management offers a less invasive alternative.
- Oral and parenteral caffeine are the most common pharmacologic treatments.
- Theophylline, sumatriptan, epidural fluids/drugs, epidural adrenocorticotropic hormone, and epidural morphine show potential but require further study.
- Individual patient characteristics must be considered in treatment decisions.
Conclusions:
- Intravenous and oral caffeine are effective and noninvasive PDPH treatments.
- Epidural NaCl 0.9% or dextran are alternatives if EBP is unsuccessful or contraindicated.
- Multiple pharmacologic management methods exist but need further evaluation.
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