title: Post-epidural headache: how late can it occur?
abstract: BACKGROUND
  Complications of labor epidural anesthesia include a post-dural puncture headache (PDPH). A 2003 meta-analysis described the onset of PDPH as occurring from 1 to 7 days after the procedure. Presented here is the first published case of a PDPH occurring 12 days postpartum.
  
  
  METHODS
  Twelve days after an uncomplicated labor epidural a patient was awakened by a "crushing" postural headache. The initial diagnosis was "possible subarachnoid hemorrhage." Lumbar puncture and computed tomography angiogram were normal. Despite medications a severe postural headache persisted and she was referred for an epidural blood patch. Consultants felt the headache onset after 7 days made PDPH impossible. Ultimately a delayed EBP was performed with immediate resolution of her headache.
  
  
  CONCLUSIONS
  Meta-analyses describe that parturients have a 1.5% risk of accidental dural puncture during epidural placement. Onset of the headache occurs as early as 1 or as late as 7 days after the procedure. Epidural blood patch is the most effective treatment for PDPH and a rapid response is diagnostic.
  
  
  CONCLUSIONS
  Described is the first reported case of a PDPH occurring well outside the normal range of onset 1 to 7 days after epidural anesthesia. The delayed diagnosis and treatment of PDPH in this patient illustrates the limitations of over-rigorous application of pooled analyses to the care of individual patients.
authors.affiliation: United States Air Force and the Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA.
authors.forename: Brian V
authors.initials: BV
authors.lastname: Reamy
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D017217:Blood Patch, Epidural; D005260:Female; D006801:Humans; D015201:Meta-Analysis as Topic; D051299:Post-Dural Puncture Headache / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011183:Postoperative Complications; D013129:Spinal Puncture / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome