title: Unintentional dural puncture with a Tuohy needle increases risk of chronic headache.
abstract: BACKGROUND
  Neuraxial analgesia is chosen by almost half of women who give birth in the United States. Unintentional dural puncture is the most common complication of this pain management technique, occurring in 0.4% to 6% of parturients. Severe positional headaches develop acutely in 70% to 80% of these parturients. Acute postdural puncture headaches are well known, but few studies have investigated long-term sequelae. We investigated the incidence of and risk factors for chronic headache and chronic back pain in parturients who experienced unintentional dural puncture with a 17-gauge Tuohy needle compared with matched controls.
  
  
  METHODS
  In a case control design, 40 parturients who sustained unintentional dural puncture with a 17-gauge Tuohy needle over an 18-month period and 40 controls matched for age, weight, and time of delivery were recruited by telephone and 2 validated questionnaires were administered assessing headache and back pain symptoms 12 to 24 months after delivery.
  
  
  RESULTS
  The incidence of chronic headaches in the study group (28%) was significantly higher than in the matched controls (5%) (OR = 7, P = 0.0129). Subjects who experienced dural punctures were more likely than controls to report chronic back pain (OR = 4, P = 0.0250), but treatment with an epidural blood patch was not a risk factor for chronic back pain.
  
  
  CONCLUSIONS
  Patients who incur unintentional dural punctures with large-gauge needles are surprisingly likely to continue to suffer chronic headaches. Treatment with an epidural blood patch does not enhance the risk of chronic back pain. The pathophysiology underlying these symptoms and the best treatment for this syndrome are not known.
authors.affiliation: College of Physicians & Surgeons, Columbia University, New York, New York, USA.
authors.forename: Christopher Allen-John
authors.initials: CA
authors.lastname: Webb
authors.forename: Paul David
authors.initials: PD
authors.lastname: Weyker
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Susan
authors.initials: S
authors.lastname: Stanley
authors.forename: D Tyler
authors.initials: DT
authors.lastname: Coyle
authors.forename: Timothy
authors.initials: T
authors.lastname: Tang
authors.forename: Richard M
authors.initials: RM
authors.lastname: Smiley
authors.forename: Pamela
authors.initials: P
authors.lastname: Flood
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D001416:Back Pain / Q000209:etiology; D017217:Blood Patch, Epidural; D059350:Chronic Pain / Q000209:etiology; D004388:Dura Mater / Q000293:injuries*; D004867:Equipment Design; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D009339:Needles; D009519:New York City; D016017:Odds Ratio; D010147:Pain Measurement; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D055815:Young Adult