[Risk factors and treatment of post-dural puncture headache-an analysis of the German patients of the international EPIMAP study].

Abstract

Background: Accidental dural puncture (ADP) is a rare but serious complication that can lead to post-dural puncture headache (PDPH), a condition known to significantly impair the well-being of affected women.

Objectives: The present study examines the patient characteristics, symptoms, management and outcomes of women with PDPH after ADP and focuses on differences between conservative management and epidural blood patch (EBP).

Materials and methods: The data of nine German study sites of the European prospective, multicenter cohort EPIMAP (European Practice in the Management of Accidental Dural Puncture in Obstetrics) trial were analyzed. Only descriptive analyses were performed due to the small sample size.

Results: Data were collected between 2016 and 2018 and 73 patients were included in Germany. Of the 73 patients (76.7%), 56 received an EBP and 17 were treated conservatively (23.3%). In the conservative treatment group, the median numeric rating score of pain (NRS) plus interquartile range (IQR) during the hospital stay was 2 (1; 3) at rest and 7 (5; 8) while sitting or standing. Upon discharge, the NRS had decreased to 0 (0; 1) at rest and 2 (1; 4) while sitting or standing. In the EBP group NRS was 3 (1; 7) at rest and 8.5 (7; 10) while sitting or standing 6-12 h before the intervention. Furthermore, 24 h after the EBP, NRS was 0 (0; 2) at rest and 1 (0; 2) while sitting or standing. A total of 15 women were readmitted to the hospital for recurrent PDPH after EBP (26.8%). A second EBP was administered to 9 patients (60%).

Conclusion: The EBP is an effective treatment option for post-puncture dural headache. The choice between the EBP and a conservative treatment seems to be influenced by the intensity of the PDPH. These results underline the importance of an individual treatment approach in patients with PDPH.