Post dural puncture headache or Spinal headache

Posted by e-Medical PPT Tuesday, September 7, 2010
Post dural puncture headache or Spinal headache occurs in up to 30% of those who undergo a lumbar puncture or spinal anesthesia.During a spinal tap, a sample of cerebrospinal fluid is withdrawn from the spinal canal and in spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body.If spinal fluid leaks through the puncture site, the patient may develop a spinal headache.Most spinal headaches resolve on their own with no treatment. But if it is lasting 24 hours or more may need treatment.
PDPH typically appear within 12 to 24 hours after a spinal tap or spinal anesthesia and presents with symptoms such as headache and nausea that typically worsen when the patient assumes an upright posture.Spinal headaches are also accompanied by Dizziness,Ringing in the ears,Nausea and Visual changes.It is thought to result from a loss of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms.
Treatment for spinal headaches begins conservatively.It is recommended the bed rest and oral pain relievers. If it hasn't improved within 24 hours,Patients with PDPH may require one or more of the following treatments.
* Epidural blood patch. Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache. This is the usual treatment for persistent spinal headaches that don't resolve on their own.
* Intravenous caffeine. Delivered directly into your bloodstream, caffeine helps relieve spinal headaches — usually within a few hours — by constricting blood vessels within your head.
* Epidural saline. Injecting a saltwater solution into the space outside the membrane that covers your spinal cord may put pressure on the lumbar puncture site and stop the cerebrospinal fluid leak. But because saline solution is absorbed so quickly by the body, spinal headaches often recur after this treatment.

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