Postdural Ponksiyon Baş Ağrısı (PDPH)
Synopsis
Post-dural puncture headache (PDPH) is a secondary headache that develops due to dural puncture and subsequent leakage of cerebrospinal fluid (CSF) following spinal or epidural anesthesia, as well as diagnostic or therapeutic lumbar puncture. The decrease in CSF pressure causes traction on meningeal and intracranial structures alongside compensatory intracerebral vasodilation, resulting in orthostatic headache. While young age, female gender, pregnancy, low body mass index, the use of cutting needles, and repeated puncture attempts increase the risk of PDPH, preferring atraumatic conical needles (Sprotte, Whitacre) and small-gauge needles significantly reduces its incidence. Symptoms typically appear within 12 to 72 hours after dural puncture, with the most characteristic feature being worsening within 15 minutes of standing or sitting and relief within 30 minutes of lying flat. The headache may be accompanied by neurological manifestations such as neck stiffness, tinnitus, photophobia, nausea, auditory sensitivity, and diplopia secondary to cranial nerve traction. Diagnosis is supported by a history of dural puncture, the typical clinical presentation, and imaging techniques such as MRI and CT myelography, which demonstrate dural contrast enhancement or CSF leakage. In management, conservative approaches such as bed rest and oral hydration are applied in the first 24 to 48 hours, while caffeine, theophylline, ACTH, gabapentinoids, and corticosteroids are among the medical treatment options. In severe cases where conservative and medical measures are insufficient, the autologous epidural blood patch—considered the gold standard—is performed; additionally, invasive procedures such as greater occipital nerve block (GOBN) and transnasal sphenopalatine ganglion block (SPGB) serve as effective therapeutic alternatives.
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