Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthetic procedures resulting in an acute postural headache within five days of a dural puncture (Minerva Anestesiol 2019;85:543-53). Patients generally experience a severe, dull, frontal or occipital headache, often associated with neck pain, tinnitus or muffled hearing, and nausea. Pain classically worsens in the upright position and is caused by leakage of cerebrospinal fluid into the epidural space resulting in “brain sag” and compensatory cerebral vasodilatation. The incidence of PDPH after dural puncture depends on procedural and patient factors; a 25-27g, pencil point spinal needle will rarely cause any PDPH symptoms in an elderly male patient undergoing hip arthroplasty, whereas an unintentional dural puncture (UDP) with a large epidural needle in a young, laboring woman causes headache in 50% to 80% of patients (Int J Obstet Anesth 2008;17:329-35; Can J Anaesth 2019;66:1464-71).
In the 2004-09 multicenter...
