Can post-dural puncture headache (PDPH) be prevented?

From the Guidelines

Let down headaches, also known as post-dural puncture headaches, can be prevented by using atraumatic needles, maintaining a lying position during the procedure, and ensuring the patient is well-hydrated. To prevent these headaches, which occur when cerebrospinal fluid (CSF) leaks through the dural puncture, several strategies can be employed.

• Using atraumatic needles has been shown to reduce the risk of post-dural puncture headache (PDPH) 1.
• Maintaining a lying position during the procedure may also help prevent PDPH, as sitting position has been associated with an increased risk of severe headache 1.
• Ensuring the patient is well-hydrated before and after the procedure can also help prevent dehydration, which can trigger or exacerbate headaches.
• Additionally, factors such as age greater than 65 years and the presence of dementia have been associated with a reduced risk of typical post-LP headache 1. It is essential to note that while these strategies can help prevent let down headaches, they may not completely eliminate the risk.
• The use of conservative measures such as bed rest is not recommended as a routine treatment for PDPH, although it may be used as a temporizing measure for symptomatic relief 1.
• The definition of PDPH by the International Headache Society (IHS) requires evidence of low pressure or CSF leakage on cerebral imaging, and the headache is usually accompanied by neck stiffness and/or subjective hearing symptoms 1. Overall, preventing let down headaches requires a multifaceted approach that takes into account the patient's individual risk factors and the procedural details of the lumbar puncture.

From the Research

Let Down Headache Prevention

There are no direct research papers to assist in answering this question, as the provided studies focus on migraine treatments during breastfeeding, pregnancy, and headache management in general. However, some studies provide information on headache prevention and management during breastfeeding and pregnancy, which may be relevant to let down headache prevention.

• The study 2 discusses the safety of common migraine treatments during breastfeeding, but does not provide information on let down headache prevention.
• The study 3 reviews the lactation risk of anti-migraine drugs, but does not address let down headache prevention.
• The study 4 explains the relation of sex hormones that trigger migraine and reviews therapeutic approaches for migraine in pregnancy and breastfeeding, but does not provide information on let down headache prevention.
• The study 5 highlights the importance of lifestyle modifications in preventing headaches at a developmental age, which may be relevant to let down headache prevention.
• The study 6 conducts a systematic review of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding, but finds insufficient evidence regarding non-pharmacologic treatments and does not address let down headache prevention specifically.

Relevant Findings

While there is no direct evidence on let down headache prevention, the studies suggest that:

• Breastfeeding is not prohibited by migraines, and steady estrogen levels during lactation may function as a protective factor 4.
• Non-pharmacological techniques should always be used as the first line of treatment 4.
• Lifestyle modifications, such as a perfect balance between regular sleep and meal, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, and regular physical activity, may help prevent headaches 5.