Differential Diagnosis for Post Epidural Headache
- Single most likely diagnosis
- Post-dural puncture headache (PDPH): This is the most common cause of headache after epidural procedures, occurring due to leakage of cerebrospinal fluid (CSF) through the dural puncture site, leading to decreased CSF pressure and brain sagging.
- Other Likely diagnoses
- Tension headache: Could be exacerbated or triggered by the stress of the procedure or positioning during the epidural.
- Migraine: Patients with a history of migraines may experience an episode triggered by the procedure or its aftermath.
- Caffeine withdrawal headache: If the patient is a regular consumer of caffeine and it is withheld post-procedure, this could contribute to headache.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although rare, any sudden, severe headache after an epidural procedure warrants consideration of this potentially life-threatening condition.
- Epidural hematoma: Bleeding into the epidural space can compress the spinal cord, leading to severe neurological deficits if not promptly addressed.
- Meningitis: Infection introduced during the procedure could lead to meningitis, which is a medical emergency.
- Rare diagnoses
- Pseudomeningocele: A collection of CSF that can occur at the site of the dural puncture, potentially causing headache and other neurological symptoms.
- Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal cord, which could be caused by the epidural procedure, though this is exceedingly rare.
- Intracranial hypotension due to other causes (e.g., spontaneous intracranial hypotension): While the context suggests PDPH, other causes of intracranial hypotension should be considered if the clinical picture does not fit typical PDPH or does not respond to standard treatments.