Conclusions
Spinal headache is a scourge for patients and their physicians. Since it is an entirely iatrogenic problem it can induce strong emotions on either side, in particular patient resentment and physician guilt. Most of the studies on spinal headache were done 30–40 years ago when clinical trials were not carried out in a manner acceptable to today’s scientific community and statistical analysis was not used. It is hard to draw any conclusions from most of this work and there are still many unanswered questions.
Conclusions
La céphalée rachidienne est ennuyeuse autant pour les patients que pour leur médicin. Puisque e’est un problème totalement iatrogénique, elle peut créer des réactions émotives de chaque côté, en particulier un ressentiment du patient et la culpabilité chez le médicin. La plupart des études sur la céphalée rachidienne ont été exécutées il y a 30 ou 40 ans alors que les études cliniques n’étaient pas conduites avec des méthodes acceptables à la communauté scientifique actuelle et l’on n’utilisait pas d’analyse statistique à l’époque. Il est difficile de tirer quelque conclusion que ce soit de la plupart de ces travaux. Il y a encore beaucoup de questions sans réponse.
Article PDF
Similar content being viewed by others
References
Kunkle C, Bronson R, Wolff H. Experimental studies on headache. Arch Neurol 1943: 49: 323–58.
Ahearn R. Management of severe post lumbar puncture headache. NY State J Med 1948; 48: 1495–8.
Kaplan G. The psychogenic etiology of headache post lumbar puncture. Psychosom Med 1967; 29: 376–9.
Stein G, Morton J, Marsh A et al. Headaches after childbirth. Acta Neurol Scand 1984; 69: 74–9.
Crawford JS. The prevention of headache subsequent upon dural puncture. Br J Anaesth 1972; 44: 598–9.
Vandam LD, Dripps RD. Long-term follow-up of patients who received 10,098 spinal anaesthetics. JAMA 1956; 161: 586–91.
Greene B. A 26 gauge lumbar puncture needle: its value in the prophylaxis of headache following spinal anaesthesia for vaginal delivery. Anesthesiology 1950; 11: 464–9.
Thornberry E, Thomas T. Posture and post-spinal headache. Br J Anaesth 1988; 60: 195–7.
Bolder PM. Postlumbar puncture headache in pediatric oncology patients. Anesthesiology 1986; 65: 696–8.
Benzon HT, Linde HW, Molloy RE et al. Post dural puncture headache in patients with chronic pain. Anesth Analg 1980; 59: 772–4.
Tourtelotte W, Henderson W, Tucker R et al. A randomized, double-blind clinical trial comparing the 22 gauge versus the 26 gauge needle in the production of the post lumbar puncture syndrome in normal individuals. Headache 1972; 12: 73–8.
Sechzer P, Abel L. Post-spinal analgesia headache treated with caffeine: evaluation with the demand method. Part I. Current Therapeutic Research 1978; 24: 307–12.
Dodd JE, Efird RC.Rauck RL. Cerebral blood flow changes with caffeine thereapy for postdural headaches (Abstr). Anesthesiology 1989; 71: A679.
Bolton VE, Leicht CH, Scanlon TS. Postpartum seizure after epidural blood patch and intravenous caffeine sodium benzoate. Anesthesiology 1989; 70: 146–9.
Gormley JB. Treatment of post-spinal headache. Anesthesiology 1960; 21: 565–6.
Di Giovanni A, Dunbar B. Epidural injections of autologous blood for post lumbar puncture headache. Anesth Analg 1970; 49: 268–71.
Di Giovanni A, Galbert M, Wahle W. Epidural injections of autologous blood for post lumbar puncture headache: additional clinical experiences and laboratory investigation. Anesth Analg 1972; 51: 226–32.
Crawford. Epidural blood patch. Anaesthesia 1985; 40: 381.
Szeinfeld M, Ihmeidan I, Moser M et al. Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 1986; 64: 820–2.
Abouleish E, De La Vega S, Blendiger I et al. Long-term follow-up of blood patch. Anesth Analg 1975; 54: 459–63.
Shantha T. Complications following epidural blood patch for post lumbar puncture headache (Discussion: Case History No. 70). Anesth Analg 1973; 52: 67–72.
Cornwall R, Dolan W. Radicular back pain following lumbar epidural blood patch. Anesthesiology 1975; 43: 692–3.
Wilton N, Globerson J, De Rosayro M. Epidural blood patch for post dural puncture headache. It is never too late. Anesth Analg 1986; 65: 895–6.
Longmire S, Joyce T. Treatment of a duro-cutaneous fistula secondary to attempted epidural anaesthesia with an epidural autologous blood patch. Anesthesiology 1984; 60: 63–4.
Ong BY, Graham CR, Ringaert KR et al. Impaired epidural analgesia after dural puncture with and without subsequent blood patch. Anesth Analg 1990; 70: 76–9.
Parris W. Use of epidural blood patch in treating chronic headache: report of six cases. Can J Anaesth 1987; 34: 403–5.
Gibson B, Wedel, D.Faust R et al. Continuous epidural saline infusion for the treatment of low CSF pressure headache. Anesthesiology 1988; 68: 789–91.
Barrios-Alarcon J, Aldrete JA, Paragas-Tapia D. Relief of post-lumbar puncture headache with epidural Dextran 40: a preliminary report. Reg Anesth 1989; 14: 78–80.
Rice G, Dabbs H. The use of peridural subarachnoid injection of saline solution in the treatment of severe post spinal headache. Anesthesiology 1950; 11: 17–23.
Usubiaga J, Usubiaga L, Brea L et al. Effect of saline injections on epidural and subarachnoid space pressures and relation to post spinal anaesthesia headache. Anesth Analg 1967; 46: 293–6.
Baysinger C, Menk E, Harte E et al. The successful treatment of dural puncture headache after failed epidural blood patch. Anesth Analg 1986; 65: 1242–4.
Bart A, Wheeler A. Comparison of epidural saline placement and epidural blood placement in the treatment of postlumbar puncture headache. Anesthesiology 1978; 48: 221–3.
Harrington H, Tyler R, Welch K. Surgical treatment of post lumbar-puncture dural CSF leak causing chronic headache. J Neurosurg 1982; 57: 703–7.
Carbaat P, Vancrevel H. Lumbar puncture headache. Controlled study in the preventive effect of 24 hours bed rest. Lancet 1981; ii: 1133–5.
Cook PT, Davies MJ, Beavis RE. Bed rest and post lumbar puncture headache. Anaesthesia 1989; 44: 389–91.
Dittmann M, Renkl F. Spinal anesthesia with extremely fine needles. Anesthesiology 1989; 70: 1035–6.
Flaaten H, Rodt SA et al. Post dural puncture headache — a comparison between 26 and 29 gauge needles in young patients. Anaesthesia 1989; 44: 147–9.
Ready LB, Cuplin S, Haschke R et al. Spinal needle determinants of rate of transdural fluid leak. Anesth Analg 1989; 69: 457–60.
Cruickshank RH, Hopkinson JM. Fluid leak through dural puncture sites. Anaesthesia 1989; 44: 415–8.
Hart JR, Whitacre RJ. Pencil-point needle in prevention of spinal headache. JAMA 1981; 147: 657–8.
Cappe BE. Prevention of post spinal headache with a 22G pencil-point needle and adequate hydration. Anesth Analg 1960; 39: 463–5.
Snyder GE, Person DL, Flor CE et al. Headache in obstetrical patients; comparison of Whitacre needle versus Quincke needle (Abstr.). Anesthesiology 1989; 71: A860.
Sami HM, Skaredoff MD. In-hospital incidence of postlumbar puncture headaches in Cesarean section patients associated with 22G Whitacre needle (Abstr). Anesthesiology 1989; 71: A861.
Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anesth Analg 1989; 69: 768–72.
Mihic D. Post spinal headache and relationship of needle bevel to longitudinal dural fibers. Reg Anesth 1985; 10: 76–81.
Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after dural puncture. Anesthesiology 1989; 70: 729–31.
Harfalvi, BI. The dynamics of post-spinal headache. Headache 1977; 17: 64–6.
Ravindran R, Viegas O, Taseh M et al. Bearing down and the incidence of spinal headache in parturients. Anesth Analg 1981; 60: 524–6.
Dieterich M, Brandt T. Incidence of post-lumbar puncture headache is independent of fluid intake. Eur Arch Psychiatry Neurol Sci 1988; 237: 194–6.
Craft J, Epstein B, Coakley C. Prophylaxis of duralpuncture headache with epidural saline. Anesth Analg 1973; 52: 228–31.
Beck W. Prevention of the post partum spinal headache. Am J Obstet Gynecol 1973; 115: 354–6.
Ackerman W, Juneja M, Kaczorowski D. The attenuation of a post dural puncture headache with a prophylactic blood patch in labor patients (Abstr). Anesth Analg 1989; 68: S1.
Colonna-Romano P, Sharpiro BE. Unintentional dural puncture and prophylactic epidural blood patch in obstetrics. Anesth Analg 1989; 69: 522–3.
Gutterman P, Bezier H. Prophylaxis of post myelogram headache. J Neurol 1978; 49: 869–71.
Recent review articles
Mulroy MF. Spinal headaches: management and avoidance. Problems in Anesthesia 1987; 1: 602–11.
Gielen M. Post dural puncture headache (PDPH): a review. Reg Anesth 1989; 14: 101–6.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weeks, S.K. Spinal headache — prevention and treatment. Can J Anaesth 37 (Suppl 1), Sliii–Slxiii (1990). https://doi.org/10.1007/BF03006274
Issue Date:
DOI: https://doi.org/10.1007/BF03006274