title: Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial.
abstract: OBJECTIVE
  To determine the efficacy of epidural blood patch (EDBP) for the treatment of post dural puncture headache (PDPH).
  
  
  METHODS
  We randomised 42 patients who presented with PDPH, lasting 24 h to 1 week, to receive EDBP (n = 19) or conservative treatment (n = 23). The primary end point was any headache at 24 h after the start of treatment. Secondary end points were presence and severity of headache after 1 week. Stratified Mantel-Haenzel analysis was used to adjust for confounders.
  
  
  RESULTS
  Two patients refused to participate directly after randomisation and allocation to conservative treatment. They were excluded from the study. At 24 h after the start of treatment, headache was present in 11 (58%) patients allocated to EDBP and in 19 (90%) patients allocated to conservative treatment (RR 0.64, 95% CI 0.43 to 0.96). At day 7, headache was present in three (16%) patients allocated to EDBP and in 18 (86%) allocated to conservative treatment (RR 0.18, 95% CI 0.06 to 0.53). Headache was mild in all three EDBP patients, but in 10 of 18 conservatively treated patients who had not recovered by day 7 it was classified as moderate or severe. Adjustments for confounders did not affect these results.
  
  
  CONCLUSIONS
  EDBP is an effective treatment for PDPH. It offers complete resolution of symptoms in a large proportion of patients. In the remaining patients, it reduces headache severity and allows them to return to their everyday activities.
authors.affiliation: Department of Neurology, Erasmus Medical Centre, PO Box 2040 3000 CA Rotterdam, The Netherlands. f.vankooten@erasmusmc.nl
authors.forename: F
authors.initials: F
authors.lastname: van Kooten
authors.forename: R
authors.initials: R
authors.lastname: Oedit
authors.forename: S L M
authors.initials: SL
authors.lastname: Bakker
authors.forename: D W J
authors.initials: DW
authors.lastname: Dippel
mesh_terms: D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D017217:Blood Patch, Epidural; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D051299:Post-Dural Puncture Headache / Q000628:therapy*; D016037:Single-Blind Method; D013129:Spinal Puncture; D016896:Treatment Outcome