Abstract
Chronic headaches are difficult problems to manage effectively. A select group of six patients with headache symptoms (throbbing headaches, located in the frontal or occipital areas; aggravated by ambulation and relieved by recumbency) resembling post-dural puncture headache received epidural blood patches using autologous blood for their chronic headaches. Five of the six patients obtained effective and sustained pain relief. All of the patients had received placebo injections with normal saline in the paraspinous muscles, without effect. The mechanism of action of the blood patch in these patients is unclear. It is possible that the headache may have been caused by a low pressure cerebrospinal fluid state, due to an unknown anatomical or physiological defect of the ventriculo-spinal system. Further studies are needed to evaluate this treatment modality.
Résumé
Il est difficile de traiter efficacement les céphalées chroniques. Un groupe de six patients souffrant de maux de tête (céphalées lancinantes, situées dans les régions frontales et occipitales; dont la douleur empirait à la mobilisation et s’allégeait en position couchée) semblables à une céphalée se produisant à la suite ďune ponction de la dure-mère, ont été choisis pour recevoir des calfeutraage sanguins “blood patch” périduraux de sang autologue pour leurs céphalées chroniques. Pour cinq des six patients le soulagement de la douleur fut efficace et soutenu. On avait injecté des placebos de salin normal dans les muscles paraspinaux de tous les patients et ce, sans résultat. Nous ne sommes pas certain du mécanisme ďaction du calfeutrage sanguin chez ces patients. Il se peut qu’un état de basse pression du liquide céphalorachidien en raison ďun défaut anatomique ou physiologique du système ventriculorachidien soit la cause de la céphalée. Des études contrôlées plus poussées sont nécessaires afin ďévaluer ce genre de traitement.
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Parris, W.C.V. Use of epidural blood patch in treating chronic headache: Report of six cases. Can J Anaesth 34, 403–406 (1987). https://doi.org/10.1007/BF03010144
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DOI: https://doi.org/10.1007/BF03010144