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Post-dural puncture headaches in children. A literature review

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An Erratum to this article was published on 28 May 2003

Abstract

Post-dural puncture headache (PDPH) is a well recognised complication of spinal and epidural anaesthesia. It can also occur after diagnostic or therapeutic lumbar puncture. Few cases have been reported in children. We reviewed the literature regarding definition, aetiology, incidence, risk factors, prevention and treatment, in order to provide some recommendations. Significant factors include age, gender, needle diameter, needle tip design, orientation of the tip during puncture, previous PDPH, history of migraine and repeated attempts to achieve puncture. There is no evidence for the use of increased fluids or bed rest to prevent PDPH. Once the diagnosis is made, conservative therapy is recommended for 48 h. Persistent PDPH can be treated in several ways; an epidural blood patch is one of the most effective methods. Conclusion: occurrence of post-dural puncture headache after lumbar puncture in children is rare. There are conflicting data about risk factors, prevention and treatment.

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Fig. 1.

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Abbreviations

EBP :

epidural blood patch

LP :

lumbar puncture

PDPH :

post-dural puncture headache

References

  1. Berger CW, Crosby ET, Grodecki W (1998) North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth 45: 110–114

    Article  CAS  PubMed  Google Scholar 

  2. Broadley SA, Fuller GN (1997) Lumbar puncture needn't be a headache. BMJ 315: 1324–1325

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 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  CAS  PubMed  Google Scholar 

  4. Carrero EJ, Agusti M, Fabregas N, Valldeoriola F, Fernandez C (1998) Unilateral trigeminal and facial nerve palsies associated with epidural analgesia in labour. Can J Anaesth 45: 893–897

    Article  CAS  PubMed  Google Scholar 

  5. Choi A, Laurito CE, Cunningham FE (1996) Pharmacologic management of postdural puncture headache. Ann Pharmacother 30: 831–839

    Article  CAS  PubMed  Google Scholar 

  6. Despond O, Meuret P, Hemmings G (1998) Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles. Can J Anaesth 45: 1106–1109

    Article  CAS  PubMed  Google Scholar 

  7. Duffy PJ, Crosby ET (1999) The epidural blood patch. Resolving the controversies. Can J Anaesth 46: 878–886

    Article  CAS  PubMed  Google Scholar 

  8. Eledjam JJ, Viel E, Aya G, Mangin R (1993) Postdural puncture headache. Cah Anesthesiol 41: 579–588

    CAS  PubMed  Google Scholar 

  9. Eriksson AL, Hallen B, Lagerkranser M, Persson E, Skoldefors E (1998) Whitacre or Quincke needles: does it really matter. Acta Anaesthesiol Scand Suppl 113: 17–20

    Article  CAS  PubMed  Google Scholar 

  10. Evans RW, Armon C, Frohman EM, Goodin DS (2000) Assessment: prevention of post-lumbar puncture headaches. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 55: 909–914

    Article  CAS  PubMed  Google Scholar 

  11. Fernandez E (1990) Headaches associated with low spinal fluid pressure. Headache 30: 122–128

    Article  CAS  PubMed  Google Scholar 

  12. Ghelardini C, Galeotti N, Bartolini A (1997) Caffeine induces central cholinergic analgesia. Naunyn Schmiedebergs Arch Pharmacol 356: 590–595

    Article  CAS  PubMed  Google Scholar 

  13. Hess JH (1991) Postdural puncture headache: a literature review. AANA J 59: 549–555

    CAS  PubMed  Google Scholar 

  14. Jeanjean P, Montpellier D, Carnee J, Crasquin O, Koral E, Line B, Letendart MH, Fricault E, Ossart M (1997) Headaches after spinal anaesthesia: prospective multicenter study of a young adult population. Ann Fr Anesth Reanim 16: 350–353

    Article  CAS  PubMed  Google Scholar 

  15. Khurana RK (1996) Intracranial hypotension. Semin Neurol 16: 5–10

    Article  CAS  PubMed  Google Scholar 

  16. Kokki H, Salonvaara M, Herrgard E, Onen P (1999) Postdural puncture headache is not an age-related symptom in children: a prospective, open-randomized, parallel group study comparing a 22-gauge Quincke with a 22-gauge Whitacre needle. Paediatr Anaesth 9: 429–434

    Article  CAS  PubMed  Google Scholar 

  17. Kokki H, Heikkinen M, Turunen M, Vanamo K, Hendolin H (2000) Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children. Acta Anaesthesiol Scand 44: 210–213

    Article  CAS  PubMed  Google Scholar 

  18. Lambert DH, Hurley RJ, Hertwig L, Datta S (1997) Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth 22: 66–72

    Article  CAS  PubMed  Google Scholar 

  19. Lybecker H, Moller 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  CAS  PubMed  Google Scholar 

  20. Lybecker H, Djernes M, Schmidt JF (1995) Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand 39: 605–612

    Article  CAS  PubMed  Google Scholar 

  21. Lynch J, Arhelger S, Krings-Ernst I (1992) Post-dural puncture headache in young orthopaedic in-patients: comparison of a 0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-gauge) Whitacre spinal needle in 200 patient. Acta Anaesthesiol Scand 36: 58–61

    Article  CAS  PubMed  Google Scholar 

  22. Martin R, Jourdain S, Clairoux M, Tetrault JP (1994) Duration of decubitus position after epidural blood patch. Can J Anaesth 41: 23–25

    Article  CAS  PubMed  Google Scholar 

  23. Morewood GH (1993) A rational approach to the cause, prevention and treatment of postdural puncture headache. CMAJ 149: 1087–1093

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Peterman SB (1996) Postmyelography headache rates with Whitacre versus Quincke 22-gauge spinal needles. Radiology 200: 771–778

    Article  CAS  PubMed  Google Scholar 

  25. Ramamoorthy C, Geiduschek JM, Bratton SL, Miser AW, Miser JS (1998) Postdural puncture headache in pediatric oncology patients. Clin Pediatr (Phila) 37: 247–251

    Google Scholar 

  26. Ross BK, Chadwick HS, Mancuso JJ, Benedetti C (1992) Sprotte needle for obstetric anesthesia: decreased incidence of post dural puncture headache. Reg Anesth 17: 29–33

    CAS  PubMed  Google Scholar 

  27. Roy L, Vischoff D, Lavoie J (1995) Epidural blood patch in a seven-year-old child. Can J Anaesth 42: 621–624

    Article  CAS  PubMed  Google Scholar 

  28. Seeberger MD, Kaufmann M, Staender S, Schneider M, Scheidegger D (1996) Repeated dural punctures increase the incidence of postdural puncture headache. Anesth Analg 82: 302–305

    CAS  PubMed  Google Scholar 

  29. Serpell MG, Rawal N (2000) Headaches after diagnostic dural punctures. BMJ 321: 973–974

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Smeltzer JS (2001) Headaches after diagnostic lumbar puncture [letter]. BMJ 322: 993

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Souron V, Simon L, Hamza J (1999) Dural taps in peridural analgesia for labor: management by French anesthesiologists in 1997. Ann Fr Anesth Reanim 18: 941–948

    Article  CAS  PubMed  Google Scholar 

  32. Taivainen T, Pitkanan M, Tuominen M, Rosenberg PH (1993) Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand 37: 702–705

    Article  CAS  PubMed  Google Scholar 

  33. Thomas SR, Jamieson DRS, Muir KW (2000) Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. BMJ 321: 986–990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Tobias Joseph D (1994) Postdural puncture headache in children. Etiology and treatment. Clin Pediatr 33: 110–113

    Article  CAS  Google Scholar 

  35. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S (2000) Postdural puncture headache: a randomised comparison of five spinal needles in obstetric patients. Anesth Analg 91: 916–920

    Article  CAS  PubMed  Google Scholar 

  36. Van de Velde M, Corneillie M, Vanacker B, Stevens E, Verhaeghe J, Van Assche A, Vandermeersch E (1999) Treatment for postdural puncture headache associated with late postpartum eclampsia. Acta Anaesthesiol Belg 50: 99–102

    Google Scholar 

  37. Vimala J, Peter JV, Jeyaseelan L, Prabhakar S, Cherian AM (1998) Post lumbar puncture headache: is bed rest essential? J Assoc Physicians India 46: 930–932

    CAS  PubMed  Google Scholar 

  38. Westbrook JL, Uncles DR, Sitzman BT, Carrie LE (1994) Comparison of the force required for dural puncture with different spinal needles and subsequent leakage of cerebrospinal fluid. Anesth Analg 79: 769–772

    Article  CAS  PubMed  Google Scholar 

  39. Wiesel S, Tessler MJ, Easdown LJ (1993) Postdural puncture headache: a randomised prospective comparison of the 24 gauge Sprotte and the 27 gauge Quincke needles in young patients. Can J Anaesth 40: 607–611

    Article  CAS  PubMed  Google Scholar 

  40. Ylönen P, Kokki H (2002) Epidural blood patch for management of postdural puncture headache in adolescents. Acta Anaesthesiol Scand 46: 794–798

    Article  Google Scholar 

  41. Yucel A, Ozyalcin S, Talu GK, Yucel EC, Erdine S (1999) Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 24: 51–54

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics, Catholic University of Leuven, Leuven, Belgium

    Elke Janssens

  2. Paediatric Department, Virga Jesseziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium

    Peter Aerssens, Phillipe Alliët, Phillipe Gillis & Marc Raes

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  1. Elke Janssens
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  2. Peter Aerssens
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  3. Phillipe Alliët
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  4. Phillipe Gillis
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  5. Marc Raes
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Correspondence to Marc Raes.

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A correction to this article is available at http://dx.doi.org/10.1007/s00431-003-1271-2

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Janssens, E., Aerssens, P., Alliët, P. et al. Post-dural puncture headaches in children. A literature review. Eur J Pediatr 162, 117–121 (2003). https://doi.org/10.1007/s00431-002-1122-6

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  • DOI: https://doi.org/10.1007/s00431-002-1122-6

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