title: Post dural puncture headache in obstetric patients: experience from a West African teaching hospital.
abstract: BACKGROUND
  This prospective, non-randomised study examined the frequency and severity of post dural puncture headache in 96 Ghanaian women who consented to spinal anaesthesia for caesarean section at the Korle Bu Teaching Hospital, Accra, Ghana.
  
  
  METHODS
  Spinal anaesthesia was performed using 22-gauge (n = 22), 25-gauge (n = 46) or 26-gauge (n = 38) Quincke needles. Patients were followed up to determine the incidence and severity of post spinal headache.
  
  
  RESULTS
  The overall incidence of post dural puncture headache was 8.3%, but was significantly higher (33%) in patients in whom 22-gauge Quincke needles were used than in the other two groups (4% and 5% respectively: P = 0.003). Most patients rated their headache as mild to moderate on a 10-cm visual analogue scale.
  
  
  CONCLUSIONS
  In view of the high incidence of headache and the need for treatment associated with the use of the 22-gauge Quincke needle, we recommend that this should not be used in the obstetric population. We are also aware that the incidence of post dural puncture headache could be further reduced by the use of small calibre pencil-point needles but these are currently very expensive and many obstetric units in developing countries may not be able to afford them.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48109-0048, USA. onafiu@med.umich.edu
authors.forename: O O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: R A
authors.initials: RA
authors.lastname: Salam
authors.forename: E O
authors.initials: EO
authors.lastname: Elegbe
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D009339:Needles / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods; D051299:Post-Dural Puncture Headache / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects* / Q000295:instrumentation; D013997:Time Factors