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Management of postdural puncture headache in the obstetric patient

Thew, Melaniea; Paech, Michael Jb

Current Opinion in Anesthesiology: June 2008 - Volume 21 - Issue 3 - p 288–292
doi: 10.1097/ACO.0b013e3282f8e21a
Obstetric and gynecological anesthesia: Edited by Marc Van de Velde

Purpose of review The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007.

Recent findings New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants.

Summary The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.

aDepartment of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Australia

bPharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia

Correspondence to Professor Michael Paech, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, WA 6008, Australia Tel: +61 8 9340 2250; fax: +61 8 9340 2260; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.