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Spinal headache — prevention and treatment

La céphalée post-ponction sous-arachnoïdienne: prévention et traitement

Canadian Journal of Anaesthesia volume 37, pages Sliii–Slxiii (1990)Cite this article

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.

References

  1. Kunkle C, Bronson R, Wolff H. Experimental studies on headache. Arch Neurol 1943: 49: 323–58.

    Google Scholar 

  2. Ahearn R. Management of severe post lumbar puncture headache. NY State J Med 1948; 48: 1495–8.

    CAS  Google Scholar 

  3. Kaplan G. The psychogenic etiology of headache post lumbar puncture. Psychosom Med 1967; 29: 376–9.

    PubMed  CAS  Google Scholar 

  4. Stein G, Morton J, Marsh A et al. Headaches after childbirth. Acta Neurol Scand 1984; 69: 74–9.

    PubMed  CAS  Article  Google Scholar 

  5. Crawford JS. The prevention of headache subsequent upon dural puncture. Br J Anaesth 1972; 44: 598–9.

    PubMed  Article  CAS  Google Scholar 

  6. Vandam LD, Dripps RD. Long-term follow-up of patients who received 10,098 spinal anaesthetics. JAMA 1956; 161: 586–91.

    CAS  Google Scholar 

  7. 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.

    PubMed  CAS  Google Scholar 

  8. Thornberry E, Thomas T. Posture and post-spinal headache. Br J Anaesth 1988; 60: 195–7.

    PubMed  Article  CAS  Google Scholar 

  9. Bolder PM. Postlumbar puncture headache in pediatric oncology patients. Anesthesiology 1986; 65: 696–8.

    PubMed  Article  CAS  Google Scholar 

  10. Benzon HT, Linde HW, Molloy RE et al. Post dural puncture headache in patients with chronic pain. Anesth Analg 1980; 59: 772–4.

    PubMed  CAS  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Google Scholar 

  13. Dodd JE, Efird RC.Rauck RL. Cerebral blood flow changes with caffeine thereapy for postdural headaches (Abstr). Anesthesiology 1989; 71: A679.

    Article  Google Scholar 

  14. Bolton VE, Leicht CH, Scanlon TS. Postpartum seizure after epidural blood patch and intravenous caffeine sodium benzoate. Anesthesiology 1989; 70: 146–9.

    PubMed  Article  CAS  Google Scholar 

  15. Gormley JB. Treatment of post-spinal headache. Anesthesiology 1960; 21: 565–6.

    Google Scholar 

  16. Di Giovanni A, Dunbar B. Epidural injections of autologous blood for post lumbar puncture headache. Anesth Analg 1970; 49: 268–71.

    Google Scholar 

  17. 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.

    Google Scholar 

  18. Crawford. Epidural blood patch. Anaesthesia 1985; 40: 381.

    PubMed  CAS  Article  Google Scholar 

  19. 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.

    PubMed  Article  CAS  Google Scholar 

  20. Abouleish E, De La Vega S, Blendiger I et al. Long-term follow-up of blood patch. Anesth Analg 1975; 54: 459–63.

    PubMed  Article  CAS  Google Scholar 

  21. Shantha T. Complications following epidural blood patch for post lumbar puncture headache (Discussion: Case History No. 70). Anesth Analg 1973; 52: 67–72.

    Google Scholar 

  22. Cornwall R, Dolan W. Radicular back pain following lumbar epidural blood patch. Anesthesiology 1975; 43: 692–3.

    PubMed  Article  CAS  Google Scholar 

  23. 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.

    PubMed  Article  CAS  Google Scholar 

  24. 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.

    PubMed  Article  CAS  Google Scholar 

  25. 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.

    PubMed  Article  CAS  Google Scholar 

  26. Parris W. Use of epidural blood patch in treating chronic headache: report of six cases. Can J Anaesth 1987; 34: 403–5.

    PubMed  CAS  Google Scholar 

  27. 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.

    PubMed  Article  CAS  Google Scholar 

  28. 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.

    PubMed  CAS  Google Scholar 

  29. 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.

    PubMed  Article  CAS  Google Scholar 

  30. 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.

    PubMed  CAS  Google Scholar 

  31. 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.

    PubMed  CAS  Google Scholar 

  32. 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.

    PubMed  Article  CAS  Google Scholar 

  33. Harrington H, Tyler R, Welch K. Surgical treatment of post lumbar-puncture dural CSF leak causing chronic headache. J Neurosurg 1982; 57: 703–7.

    PubMed  CAS  Google Scholar 

  34. Carbaat P, Vancrevel H. Lumbar puncture headache. Controlled study in the preventive effect of 24 hours bed rest. Lancet 1981; ii: 1133–5.

    Article  Google Scholar 

  35. Cook PT, Davies MJ, Beavis RE. Bed rest and post lumbar puncture headache. Anaesthesia 1989; 44: 389–91.

    PubMed  Article  CAS  Google Scholar 

  36. Dittmann M, Renkl F. Spinal anesthesia with extremely fine needles. Anesthesiology 1989; 70: 1035–6.

    Article  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. Ready LB, Cuplin S, Haschke R et al. Spinal needle determinants of rate of transdural fluid leak. Anesth Analg 1989; 69: 457–60.

    PubMed  Article  CAS  Google Scholar 

  39. Cruickshank RH, Hopkinson JM. Fluid leak through dural puncture sites. Anaesthesia 1989; 44: 415–8.

    PubMed  Article  CAS  Google Scholar 

  40. Hart JR, Whitacre RJ. Pencil-point needle in prevention of spinal headache. JAMA 1981; 147: 657–8.

    Google Scholar 

  41. Cappe BE. Prevention of post spinal headache with a 22G pencil-point needle and adequate hydration. Anesth Analg 1960; 39: 463–5.

    PubMed  Article  CAS  Google Scholar 

  42. Snyder GE, Person DL, Flor CE et al. Headache in obstetrical patients; comparison of Whitacre needle versus Quincke needle (Abstr.). Anesthesiology 1989; 71: A860.

    Article  Google Scholar 

  43. 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.

    Article  Google Scholar 

  44. Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anesth Analg 1989; 69: 768–72.

    PubMed  Article  CAS  Google Scholar 

  45. Mihic D. Post spinal headache and relationship of needle bevel to longitudinal dural fibers. Reg Anesth 1985; 10: 76–81.

    Google Scholar 

  46. Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after dural puncture. Anesthesiology 1989; 70: 729–31.

    PubMed  Article  CAS  Google Scholar 

  47. Harfalvi, BI. The dynamics of post-spinal headache. Headache 1977; 17: 64–6.

    Article  Google Scholar 

  48. Ravindran R, Viegas O, Taseh M et al. Bearing down and the incidence of spinal headache in parturients. Anesth Analg 1981; 60: 524–6.

    PubMed  CAS  Google Scholar 

  49. Dieterich M, Brandt T. Incidence of post-lumbar puncture headache is independent of fluid intake. Eur Arch Psychiatry Neurol Sci 1988; 237: 194–6.

    PubMed  Article  CAS  Google Scholar 

  50. Craft J, Epstein B, Coakley C. Prophylaxis of duralpuncture headache with epidural saline. Anesth Analg 1973; 52: 228–31.

    PubMed  Article  CAS  Google Scholar 

  51. Beck W. Prevention of the post partum spinal headache. Am J Obstet Gynecol 1973; 115: 354–6.

    PubMed  Google Scholar 

  52. 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.

    Article  Google Scholar 

  53. Colonna-Romano P, Sharpiro BE. Unintentional dural puncture and prophylactic epidural blood patch in obstetrics. Anesth Analg 1989; 69: 522–3.

    PubMed  Article  CAS  Google Scholar 

  54. Gutterman P, Bezier H. Prophylaxis of post myelogram headache. J Neurol 1978; 49: 869–71.

    CAS  Google Scholar 

Recent review articles

  • Mulroy MF. Spinal headaches: management and avoidance. Problems in Anesthesia 1987; 1: 602–11.

    Google Scholar 

  • Gielen M. Post dural puncture headache (PDPH): a review. Reg Anesth 1989; 14: 101–6.

    PubMed  CAS  Google Scholar 

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Author information

Affiliations

  1. Department of Anaesthesia, Royal Victoria Hospital, Montreal, Quebec

    Sally K. Weeks

Authors
  1. Sally K. Weeks
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Weeks, S.K. Spinal headache — prevention and treatment. Can J Anaesth 37, Sliii–Slxiii (1990). https://doi.org/10.1007/BF03006274

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  • DOI: https://doi.org/10.1007/BF03006274

Keywords

  • Dural Puncture
  • Epidural Blood Patch
  • cafEine
  • Needle Bevel
  • Spinal Headache