Prevention and treatment approaches of post-dural puncture headache in obstetric patients: A comprehensive review

Neuraxial anesthesia and analgesia are administered to many patients. The incidence of dural puncture is about 1%, with a higher occurrence in laboring women. Post dural puncture headache (PDPH) develops in 60%-80% of patients after unintentional dural puncture (UDP) which is usually positional and sometimes is accompanied by neck stiffness, photophobia, nausea, or hearing symptoms. It can also drive-up healthcare costs by increasing the length of hospital stay for chronic headache and back pain. PDPH has the potential to cause significant morbidity in the obstetric patients which prolongs the hospital stay. Epidural blood patch (EBP) is considered the gold standard for the management of PDPH. Proper scheduling of analgesics and supporting the patient psychologically as she cares for her newborn is needed. If the intensity of headache is severe, additional agents may be considered. In this review, the different methods and therapeutic approaches for prevention and treatment of PDPH are comprehensively discussed.