title: [Prophylaxis and therapy of postdural puncture headache--a critical evaluation of treatment options].
abstract: Since the first description of spinal and epidural anaesthesia, postdural puncture headache (PDPH) is a well known complication. Its prophylaxis and treatment has been studied and discussed for more than 100 years, but the evidence is still limited. Due to relatively low prevalence of PDPH, prospective RCTs are often missing, and the frequently self-limiting character of PDPH impedes an adequate interpretation of results from studies without a control group. Taking side effects and complications into account, a prophylactic treatment of PDPH cannot be recommended. In case of PDPH, non-opioid analgesics are the first choice treatment. The epidural blood patch remains the mainstay of severe PDPH therapy. Noninvasive therapies like theophylline, sumatriptan and ACTH can be an alternative. However, an evidence-based recommendation is lacking. The development of standard operating procedures for accidental dural punctures and PDPH is recommended.
authors.affiliation: Klinik für Anästhesiologie und Schmerztherapie des Inselspitals, Universitätsklinikum Bern. maren.kleine-brueggeney@insel.ch
authors.forename: Maren
authors.initials: M
authors.lastname: Kleine-Brüggeney
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
authors.forename: Ulrike M
authors.initials: UM
authors.lastname: Stamer
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal; D017217:Blood Patch, Epidural; D002110:Caffeine / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000293:injuries; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D051299:Post-Dural Puncture Headache / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D011247:Pregnancy; D012702:Serotonin Antagonists / Q000627:therapeutic use; D013806:Theophylline / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D012702:Serotonin Antagonists; D014665:Vasodilator Agents; D002110:Caffeine; D009020:Morphine; D000324:Adrenocorticotropic Hormone; D013806:Theophylline