Post-Epidural Headache


Post-epidural headache, also known as post-dural puncture headache (PDPH) occurs shortly after a spinal tap procedure like an epidural. The epidural procedure has become very popular in the US since its conception in 1946. As of now, almost 60% of the women in the United States use an epidural to minimize the pain of labor(2). An epidural involves injecting a local anaesthetic into the spine close to the nerves that transmit pain signals to the brain. This procedure allows for effective pain relief within 10 to 20 minutes after administration. This procedure does have risks for both the mother and baby, which are covered here. One of the complications of this procedure happens when the dural lining of the spinal cord is accidentally punctured. This will cause a severe headache approximately one to seven days after the procedure. There have even been cases of PDPH happening much later. Here is a case report of a women suffering a post-epidural headache 12 days after her epidural!

The most common symptoms of PDPH are severe headaches that get worse when

sitting or standing, and stiffness in the neck and shoulder. Less common symptoms include: a sensitivity to light, nausea, visual disturbances, ringing in the ears, and hearing loss. PDPH typically occurs after the patients has been discharged from the hospital. It is important to note, that if bed rest, fluids, and other conservative pain management therapies are not working, to not delay hospital treatment. PDPH comes during the critical early postpartum period, when breastfeeding and bonding are being established.

The best and most effective treatment for PDPH is an epidural blood patch (EBP). An EBP involves taking some of the patients own blood and inserting it back into the affected area to help increase the cerebrospinal pressure lost during the puncture. Other forms of treatment include bed rest, intravenous fluids, intravenous caffeine, and other pain relievers.

References

Reamy, Brian V. "Post-epidural headache: how late can it occur?." The Journal of the American Board of Family Medicine 22.2 (2009): 202-205.

Anim‐Somuah, Millicent, Rebecca MD Smyth, and Leanne Jones. "Epidural versus non‐epidural or no analgesia in labour." Cochrane database of systematic reviews 12 (2011).

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