Postdural puncture headache

Sohan Parekh, Andy Jagoda

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


This chapter discusses the role of caffeine, Gabapentin, and Epidural blood patch in postdural puncture headache. Postdural puncture headache (PDPH) complicates up to 5% of spinal taps and is also frequently seen postpartum (from anesthesia-related dural puncture). The best treatment for PDPH is prevention. Although a variety of approaches to PDPH have been mentioned in reviews, the drug therapy with the most supporting evidence is caffeine. Oral formulations of caffeine (300 mg per dose) are more effective than placebo for PDPH. Thrice-daily gabapentin is reported in case series to have efficacy in PDPH. The evidence is preliminary, but administration of this anticonvulsant is of potential utility when caffeine fails or is not an option, and patients are not candidates for (or refuse) epidural blood patch. The responsibility of the acute care provider to the patient with PDPH is often administration of temporizing pharmacotherapy pending availability of an epidural blood patch.

Original languageEnglish
Title of host publicationEmergency Department Analgesia
Subtitle of host publicationAn Evidence-Based Guide
PublisherCambridge University Press
Number of pages3
ISBN (Electronic)9780511544835
ISBN (Print)9780521696012
StatePublished - 1 Jan 2008


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