Chapter 26: Postdural Puncture Headache

Brian E. Harrington

Chapter 26. Postdural Puncture Headache

In addition to headache, patients with postdural puncture headache (PDPH):

A. Are seldom nauseated

B. May develop unilateral cranial nerve palsy

C. Rarely experience associated symptoms

D. Usually experience fever

B is correct. In contrast to most bilateral and symmetric symptoms associated with PDPH, episodes of diplopia usually involve unilateral cranial nerve palsies.¹

A is incorrect. Most patients with PDPH experience nausea (the most common associated symptom).

C is incorrect. The IHS criteria for PDPH require the presence of at least one associated symptom.

D is incorrect. Fever is not associated with PDPH and should prompt investigation of other (eg, infectious) diagnoses.

The risk of developing postdural puncture headache (PDPH) is decreased with:

A. Cutting (eg, Quincke) needles

B. Female gender

C. Large-gauge needles

D. Older age

D is correct. For reasons that are incompletely understood, older patients have a lower risk of PDPH than younger patients.²

A is incorrect. The risk for PDPH is decreased with noncutting (eg, pencil-point) needles (Figure 26–1).

B is incorrect. Nonpregnant female patients have approximately double the risk for PDPH compared with age-matched male patients.

C is incorrect. Needle gauge is a major risk factor for PDPH, with meningeal puncture with large-gauge needles being associated with a greater chance of developing PDPH, more severe symptoms, and higher likelihood of needing an epidural blood patch.

Figure 26–1

Spinal needles of different manufacturers with same external diameter. Non-cutting: A: Whitacre type. B: Spinal type. C: Sprotte type. Cutting: D and E: Quincke type. Scanning electron microscopy. Magnification X40.

(Reproduced with permission from van Kooten F, Oedit R, Bakker SL, et al: Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial, Neurol Neurosurg Psychiatry. 2008 May;79(5):553-558.)