Obstetric postdural puncture headache

Postdural puncture headache (PDPH) is a complication of dural puncture resulting from cerebrospinal fluid leak associated with performance of neuraxial analgesia, neuraxial anaesthesia or a lumbar puncture. Given that neuraxial techniques are frequently employed during childbirth, PDPH is more particularly prevalent among women in the postpartum period. PDPH typically presents within 5 days post-procedure with a fronto-occipital headache, often postural in nature, accompanied by symptoms such as neck stiffness, visual and/or auditory disturbances. It affects postpartum maternal well-being, maternal–neonatal bonding and breastfeeding, and may delay hospital discharge. Untreated, PDPH has been associated with depression, chronic headache, backpain, intracranial complications such as cranial nerve palsy, subdural haematoma, cerebral venous sinus thrombosis and even maternal death. Conservative management that incorporates multi-modal analgesia and hydration are usually utilized commonly, however, an epidural blood patch remains the gold-standard for treatment of PDPH. Alternative novel treatment strategies highlighted in the literature include greater occipital and sphenopalatine nerve blocks but require more evidence to support their routine use. Timely intervention with short-term and long-term follow-up and patient education about PDPH are recommended to ensure recovery and prevent long-term sequalae of PDPH.