What are the other Names for this Condition? (Also known as/Synonyms)

• Meningeal Puncture Headache (MPH)
• PDPH (Post-Dural Puncture Headache)
• Post-Lumbar Puncture Headache

What is Post-Dural Puncture Headache? (Definition/Background Information)

• Post-Dural Puncture Headache (PDPH) is a headache disorder that occurs secondary to post-dural puncture procedures such as lumbar puncture and spinal anesthesia
• The headache that develops as a post-procedure complication within 2-5 days, is often severe with initial shooting pain that covers the entire head, progressing soon to involve the neck and sometimes the shoulders. The headache usually resolves spontaneously within about 14 days; pain medications, and if needed, epidural blood patch to close the puncture hole in the dura mater may be considered
• It is reported that the headache develops from internal cerebrospinal fluid (CSF) leakage through the dural puncture, causing reduced CSF pressure in the central nervous system (brain and spinal cord). The headache may be accompanied by other neurological signs and symptoms such as neck pain and stiffness, ringing in the ears, nausea and vomiting, balance issues, scalp numbness, hearing impairment, and dizziness
• The following independent factors are known to increase the risk for Post-Dural Puncture Headaches:
  • Young and middle-aged adults, mostly in the 18-50 years’ age group
  • Female gender; pregnant women have a higher risk
  • Individuals with low body mass index (BMI)
  • Past history of PDPH
  • Use of larger diameter needles
  • The method of performing the procedure (in terms of needle orientation)
  • According to studies, headaches are two-times more common in lumbar puncture than in spinal anesthesia
• Decreased CSF pressure can commonly cause orthostatic headaches. Individuals with orthostatic headaches may experience a significant increase in intensity of the headaches on sitting or standing up from a lying or seated position respectively. In many, the condition may improve on lying down horizontally

The criteria for diagnosis of Post-Dural Puncture Headache as outlined by the International Headache Society (IHS) is given below:

• Dural puncture has been performed
• Headache fulfilling criterion below
• Either or both of the following:
  • Low cerebrospinal fluid (CSF) pressure (less than 60 mm CSF)
  • Evidence of CSF leakage on imaging
• Headache has developed in temporal relation to the low CSF pressure or CSF leakage, or led to its discovery
• Headache has developed within 5 days of the dural puncture
• Not better accounted for by another ICHD-3 diagnosis

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)