Tinya Holzer

Date of Award


Document Type

Independent Study

Degree Name

Master of Science (MS)


Post dural puncture headache (PDPH) is a headache associated with orthostatic symptoms in which the headache increases with standing and is relieved with supine position. This type of headache arises as a result of a dural puncture either intentionally such as occurs with a subarachnoid block, or inadvertently during placement of an epidural. These symptoms can be of varying severity and usually appears within 1-3 days post dural puncture. In many cases patients are incapacitated and unable to carry out activities of daily living until treatment is received. If left untreated, 85% of PDPH resolve within six weeks, however, most new mothers are unwilling to wait that long (Sprigge, 2008). The risk factors for developing a post dural puncture headache include the size and type of needle used to make the dural puncture, female gender, patient age between 18-50, and a history of chronic or recurrent headaches. According to Sprigge & Harper (2008), the incidence of accidental dural puncture during the initiation of epidural analgesia in the obstetric population is between 0.5% and 2.5%. With these risk factors in mind one can understand why the incidence of post dural puncture headache is elevated in the obstetric population. Following accidental dural puncture for a labor epidurals 80-86% of these patients will develop a post dural puncture headache (Sprigge, 2008).

While there are a variety of treatment and prevention options used in healthcare for post dural puncture headache, this evidence based review seeks to identify the most effective interventions. A review of literature found the administration of an epidural blood patch to have the best results in the treatment of post dural puncture headaches, although rarely used as a first line treatment due to the invasiveness of the procedure (Safa-Tisseront, 200 I). Many healthcare found in this literature review did not support this practice as changing the incidence or severity of post dural puncture headache (Cook, 1989, Dietrich, 1988 & Spriggs, 1992). While the benefit of the administration of sumatriptan was not supported by the research (Connelly, 2000), caffeine administration did show a statistical significant improvement with the symptoms associated with post dural puncture headache (Camann, 1990). Other preventative measures such as the injection of normal saline or morphine into the epidural space following a dural puncture are also explored within the context of this independent project