What are the signs and symptoms of post-dural puncture headache (PDPH)?

From the Guidelines

Post-dural puncture headache (PDPH) is characterized by a severe, dull, and aching pain, often described as a pressure sensation, usually on one side of the head, but can be bilateral, typically occurring within 5 days of a lumbar puncture, as defined by the International Headache Society 1.

Common Signs and Symptoms

• The pain is usually worse when standing or sitting upright and improves or resolves when lying down, due to the orthostatic or postural nature of the headache 1.
• Other symptoms may include:
  • Neck stiffness
  • Nausea
  • Vomiting
  • Sensitivity to light or sound
  • Cranial nerve palsies, such as abducens nerve palsy, leading to diplopia

Onset and Duration

• Onset usually within 3 days of the procedure, with the majority of cases developing within 24-48 hours 1.
• Pain is typically worse in the morning and improves throughout the day.

Diagnosis and Management

Diagnosis is primarily clinical, based on the characteristic symptoms and history of recent lumbar puncture. Management of PDPH often involves conservative measures, including bed rest, hydration, caffeine, and analgesics, with epidural blood patch considered if conservative measures fail 1.

From the Research

Signs and Symptoms of Post-Dural Puncture Headache (PDPH)

• PDPH is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache 2
• Dysregulation of auditory and/or visual signals may also be present 2
• The headache is usually self-limiting and resolves within 1 week without treatment 3
• Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH 2
• Factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself may also contribute to the development of PDPH 2

Clinical Presentation

• A positional component of headache is a key feature of PDPH 4
• The headache is often worse when standing or sitting and improves when lying down 4
• A careful history can help rule out other causes of headache 4

Diagnosis

• Diagnosis of PDPH is typically based on clinical presentation and history 3, 2, 4
• Imaging studies or other diagnostic tests may be used to rule out other causes of headache 3, 2, 4

Prognosis

• PDPH is usually a self-limiting condition that resolves within 1 week without treatment 3
• However, some patients may experience chronic headache for years following dural puncture 2
• The underlying mechanism governing PDPH remains under investigation 2