Skip to main content
SpringerLink
Log in

Postpunktioneller Kopfschmerz

Post-dural puncture headache

  • CME Zertifizierte Fortbildung
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Kopfschmerzen nach Durapunktion sind eine typische Nebenwirkung rückenmarknaher Analgesieverfahren und können zu erheblichen Einschränkungen im Alltag des Patienten führen. Mit dünnen, atraumatischen Nadeln und spezieller Punktionstechnik (z. B. Wiedereinführen des Mandrins) kann ein großer Teil der Kopfschmerzen nach Spinalanästhesien vermieden werden. Zu den wirksamen Maßnahmen, die nach einer akzidentellen Durapunktion das Risiko von postpunktionellem Kopfschmerz verringern, gehört die rückenmarknahe Applikation von Morphin. Steht nach Ausschluss wichtiger, potenziell lebensbedrohlicher Differenzialdiagnosen die Diagnose postpunktionelle Kopfschmerzen fest, sind die Gaben von Koffein oder Theophyllin und Nichtopioidanalgetika wirksam zur Linderung der Symptome. Traditionelle Maßnahmen wie prophylaktische Bettruhe und Hyperhydratation werden nicht mehr empfohlen. Wird eine Intervention notwendig, ist der epidurale Blut-Patch (EBP) mit einer hohen Erfolgsrate weiterhin die Methode der Wahl.

Abstract

Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. The use of thin, atraumatic needles and special puncture techniques (e.g. reinsertion of the stylet) can prevent the majority of post-dural puncture headaches (PDPH). One of the most effective measures to prevent headache after accidental dural puncture is the intrathecal or epidural administration of morphine. When the diagnosis of PDPH is confirmed after excluding relevant differential diagnoses, some of which are potentially life-threatening, caffeine, theophylline and non-opioid analgesics are effective agents to reduce the severity of the symptoms. Traditional measures, such as strict bed rest and hyperhydration can no longer be recommended. If invasive treatment of the headache is warranted an epidural blood patch is still the method of choice with a high rate of success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Alstadhaug KB, Odeh F, Baloch FK et al (2012) Post-lumbar puncture headache. Tidsskr Nor Laegeforen 132:818–821

    Article  PubMed  Google Scholar 

  2. Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729

    Article  PubMed  CAS  Google Scholar 

  3. Bezov D, Ashina S, Lipton R (2010) Post-dural puncture headache. Part II: prevention, management, and prognosis. Headache 50:1482–1498

    Article  PubMed  Google Scholar 

  4. Ahmed SV, Jayawarna C, Jude E (2006) Post lumbar puncture headache: diagnosis and management. Postgrad Med J 82:713–716

    Article  PubMed  CAS  Google Scholar 

  5. Vandam LD, Dripps RD (1956) Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc 161:586–591

    Article  PubMed  CAS  Google Scholar 

  6. Apfel CC, Saxena A, Cakmakkaya OS et al (2010) Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth 105:255–263

    Article  PubMed  CAS  Google Scholar 

  7. Kleine-Brüggeney M, Kranke P, Stamer UM (2011) Prophylaxis and therapy of postdural puncture headache–a critical evaluation of treatment options. Anasthesiol Intensivmed Notfallmed Schmerzther 46:516–524

    Article  PubMed  Google Scholar 

  8. Sprigge JS, Harper SJ (2008) Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. Anaesthesia 63:36–43

    Article  PubMed  CAS  Google Scholar 

  9. Bezov D, Lipton RB, Ashina S (2010) Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 50:1144–1152

    Article  PubMed  Google Scholar 

  10. Reamy BV (2009) Post-epidural headache: how late can it occur? J Am Board Fam Med 22:202–205

    Article  PubMed  Google Scholar 

  11. Tohmo H, Vuorinen E, Muuronen A (1998) Prolonged impairment in activities of daily living due to postdural puncture headache after diagnostic lumbar puncture. Anaesthesia 53:299–302

    Article  PubMed  CAS  Google Scholar 

  12. Stella CL, Jodicke CD, How HY et al (2007) Postpartum headache: is your work-up complete? Am J Obstet Gynecol 196:318.e1–318.e7

    Article  PubMed  Google Scholar 

  13. Zeidan A, Farhat O, Maaliki H, Baraka A (2006) Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature. Int J Obstet Anesth 15:50–58

    Article  PubMed  CAS  Google Scholar 

  14. Ready LB, Cuplin S, Haschke RH, Nessly M (1989) Spinal needle determinants of rate of transdural fluid leak. Anesth Analg 69:457–460

    Article  PubMed  CAS  Google Scholar 

  15. Cruickshank RH, Hopkinson JM (1989) Fluid flow through dural puncture sites. Anaesthesia 44:415–418

    Article  PubMed  CAS  Google Scholar 

  16. Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82:1474–1506

    Article  PubMed  CAS  Google Scholar 

  17. Calthorpe N (2004) The history of spinal needles: getting to the point. Anaesthesia 59:1231–1241

    Article  PubMed  CAS  Google Scholar 

  18. Strupp M, Schueler O, Straube A et al (2001) „Atraumatic“ Sprotte needle reduces the incidence of post-lumbar puncture headaches. Neurology 57:2310–2312

    Article  PubMed  CAS  Google Scholar 

  19. Lybecker H, Møller JT, May O, Nielsen HK (1990) Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg 70:389–394

    Article  PubMed  CAS  Google Scholar 

  20. Strupp M, Brandt T, Müller A (1998) Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol 245:589–592

    Article  PubMed  CAS  Google Scholar 

  21. Aida S, Taga K, Yamakura T et al (1998) Headache after attempted epidural block: the role of intrathecal air. Anesthesiology 88:76–81

    Article  PubMed  CAS  Google Scholar 

  22. Beilin Y, Arnold I, Telfeyan C et al (2000) Quality of analgesia when air versus saline is used for identification of the epidural space in the parturient. Reg Anesth Pain Med 25:596–599

    PubMed  CAS  Google Scholar 

  23. Van de Velde M, Schepers R, Berends N et al (2008) Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth 17:329–335

    Article  Google Scholar 

  24. Palmer CM (2010) Continuous spinal anesthesia and analgesia in obstetrics. Anesth Analg 111:1476–1479

    Article  PubMed  Google Scholar 

  25. Bujedo BM, Santos SG, Azpiazu AU (2012) A review of epidural and intrathecal opioids used in the management of postoperative pain. J Opioid Manag 8:177–192

    Article  PubMed  Google Scholar 

  26. Sultan P, Gutierrez MC, Carvalho B (2011) Neuraxial morphine and respiratory depression. Drugs 71:1807–1819

    Article  PubMed  CAS  Google Scholar 

  27. Pöpping DM, Elia N, Marret E et al (2012) Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain 153:784–793

    Article  PubMed  Google Scholar 

  28. Gogarten W, Aken H Van (2010) Überwachungsanforderungen bei rückenmarksnahen Opioiden. Anaesthesiol Intensivmed 51:54

    Google Scholar 

  29. Costigan SN, Sprigge JS (1996) Dural puncture: the patients‘ perspective. A patient survey of cases at a DGH maternity unit 1983–1993. Acta Anaesthesiol Scand 40:710–714

    Article  PubMed  CAS  Google Scholar 

  30. Mosavy SH, Shafei M (1975) Prevention of headache consequent upon dural puncture in obstetric patient. Anaesthesia 30:807–809

    Article  PubMed  CAS  Google Scholar 

  31. Basurto Ona X, Martínez García L, Solà I, Bonfill Cosp X (2011) Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev:CD007887. doi:10.1002/14651858.CD007887.pub2

    Google Scholar 

  32. Camann WR, Murray RS, Mushlin PS, Lambert DH (1990) Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg 70:181–184

    Article  PubMed  CAS  Google Scholar 

  33. Jarvis AP, Greenawalt JW, Fagraeus L (1986) Intravenous caffeine for postdural puncture headache. Anesth Analg 65:316–317

    Article  PubMed  CAS  Google Scholar 

  34. Bolton VE, Leicht CH, Scanlon TS (1989) Postpartum seizure after epidural blood patch and intravenous caffeine sodium benzoate. Anesthesiology 70:146–149

    Article  PubMed  CAS  Google Scholar 

  35. Eldor J (1995) Opiate treatment of post dural puncture headache. Acta Anaesthesiol Scand 39:1140

    Article  PubMed  CAS  Google Scholar 

  36. Tom DJ, Gulevich SJ, Shapiro HM et al (1992) Epidural blood patch in the HIV-positive patient. Review of clinical experience. San Diego HIV Neurobehavioral Research Center. Anesthesiology 76:943–947

    Article  PubMed  CAS  Google Scholar 

  37. Chen L-K, Huang C-H, Jean W-H et al (2007) Effective epidural blood patch volumes for postdural puncture headache in Taiwanese women. J Formos Med Assoc 106:134–140

    Article  PubMed  Google Scholar 

  38. Szeinfeld M, Ihmeidan IH, Moser MM et al (1986) Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 64:820–822

    Article  PubMed  CAS  Google Scholar 

  39. Hebl JR, Horlocker TT, Chantigian RC, Schroeder DR (1999) Epidural anesthesia and analgesia are not impaired after dural puncture with or without epidural blood patch. Anesth Analg 89:390–394

    PubMed  CAS  Google Scholar 

  40. Rainbird A, Pfitzner J (1983) Restricted spread of analgesia following epidural blood patch. Case report with a review of possible complications. Anaesthesia 38:481–484

    PubMed  CAS  Google Scholar 

  41. Jagannathan N, Tetzlaff JE (2005) Epidural blood patch in a Jehovah’s Witness patient with post-dural puncture cephalgia. Can J Anaesth 52:113

    Article  PubMed  Google Scholar 

  42. Naja Z, Al-Tannir M, El-Rajab M et al (2009) Nerve stimulator-guided occipital nerve blockade for postdural puncture headache. Pain Pract 9:51–58

    Article  PubMed  Google Scholar 

  43. International Headache Society (2012) Internationale Kopfschmerz-Klassifikation (ICHD-2). http://ihs-classification.org/de/02_klassifikation/03_teil2/07.02.01_nonvascular.html

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Dresden, Deutschland

    K. Radke &  O.C. Radke DEAA

  2. Department of Anesthesia & Perioperative Care, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, 94110, San Francisco, Kalifornien, USA

    K. Radke &  O.C. Radke DEAA

Authors
  1. K. Radke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O.C. Radke DEAA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O.C. Radke DEAA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Radke, K., Radke, O. Postpunktioneller Kopfschmerz. Anaesthesist 62, 149–161 (2013). https://doi.org/10.1007/s00101-012-2115-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-012-2115-0

Schlüsselwörter

Keywords

Search

Navigation