title: Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth.
abstract: OBJECTIVE
  Is caffeine effective in preventing and treating postdural puncture headache (PDPH)?
  
  
  METHODS
  The question was addressed with a structured evidence-based clinical neurologic practice review via videoconferencing between 3 academic institutions. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarians, and clinical content experts. A critically appraised topic format was employed, starting with a clinical scenario and structured question. Participant groups at each of the 3 institutions independently devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions.
  
  
  RESULTS
  Three directly relevant randomized controlled trial articles were selected as the best available evidence for the clinical questions. Two investigated caffeine [oral and intravenous (IV)] as PDPH prophylaxis and 1 (oral) as PDPH treatment. One additional quasirandomized trial (IV) and 1 open-label trial (IV) of caffeine for PDPH treatment were located by reviewing bibliographies. Articles describing the pharmacological basis for caffeine therapy were also identified. No valid pharmacological rationale for caffeine as an antinociceptive agent for PDPH exists. The clinical trials are few in number, small in sample size, methodologically weak or flawed, and either demonstrate no effectiveness, contradictory and conflicting results, or invalid answers.
  
  
  CONCLUSIONS
  The wide endorsement for caffeine to prevent and treat PDPH found in textbooks and review articles appears to be unwarranted and insufficiently supported by the available pharmacological and clinical evidence.
authors.affiliation: Departments of Neurology, Division of Education Services, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259, USA.
authors.forename: Rashmi B
authors.initials: RB
authors.lastname: Halker
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Kay E
authors.initials: KE
authors.lastname: Wellik
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
authors.forename: Devon I
authors.initials: DI
authors.lastname: Rubin
authors.forename: Brian A
authors.initials: BA
authors.lastname: Crum
authors.forename: David W
authors.initials: DW
authors.lastname: Dodick
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D002110:Caffeine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D051299:Post-Dural Puncture Headache / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine