Case Report

Intractable Post-Dural Puncture Headache (PDPH): A Challenging Case Report

Hanwool Ryan Choi , Daniel Fernandez , Alexander Hincker , Chris Lee
Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA.
J Anesth Perioper Med 2019; 6(1): 28- 34 . Published on Jan 26, 2019 . doi:10.24015/JAPM.2019.0008
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Abstract

Post-dural puncture headache (PDPH) is a debilitating condition that can complicate a woman’s postpartum course. PDPH is commonly known to present as a positional headache in a fontal-occipital distribution that is associated with photophobia and tinnitus. However, making the diagnosis of PDPH is not always so clear-cut, and various diagnoses for postpartum headache should be ruled out prior to initiating PDPH treatments. The gold standard treatment for post-dural puncture headache is an epidural blood patch. Nevertheless, performing a blood patch may be contraindicated or may even be ineffective. Thus, it is crucial to be aware of alternative treatment modalities, ranging from pharmacologic to interventional options. In this report, we present a case of a 31-year-old woman with a prolonged course of postpartum headache that was difficult to treat. Our aim is to review and discuss the latest updates on PDPH, including its risk factors, differential diagnosis, and treatment modalities.

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