Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial.
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.
van Kooten
F
F
Department of Neurology, Erasmus Medical Centre, PO Box 2040 3000 CA Rotterdam, The Netherlands. f.vankooten@erasmusmc.nl
Oedit
R
R
Bakker
S L M
SL
Dippel
D W J
DW
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