Postdural puncture headache (PDPH), also known as a spinal headache, is a particular type of headache that occurs as a consequence of an accidental puncture in the dura mater during a spinal tap or epidural injection procedure. The dura mater is the outermost layer of the meninges, the protective coverings surrounding the brain and spinal cord. A postdural puncture headache typically begins within a few days after the procedure, although it can emerge immediately or be delayed for a week or more.
The main characteristic of a postdural puncture headache is a severe, throbbing pain in the head, particularly in the frontal or occipital region. This headache is often exacerbated by an upright posture and can be accompanied by additional symptoms such as nausea, vomiting, stiffness in the neck, sensitivity to light and sound, and ringing in the ears.
The underlying cause for this type of headache is the leakage of cerebrospinal fluid (CSF) from the puncture site, which results in a decrease in the volume and pressure of CSF around the brain and spinal cord. This reduced CSF cushioning leads to traction on pain-sensitive structures, causing the headache.
Treatment of postdural puncture headaches usually begins conservatively with oral analgesics, bed rest, and increasing fluid intake to promote CSF production. If symptoms persist or worsen, more invasive therapies may be considered, such as an epidural blood patch, which involves injecting a small amount of the patient's own blood into the epidural space, sealing the dural puncture and relieving the headache.
