title: Postdural puncture headache: a headache for the patient and a headache for the anesthesiologist.
abstract: OBJECTIVE
  To identify newly identified risk factors for the development of a postdural puncture headache (PDPH) as well as to outline the key points in the management of unintentional dural puncture and of PDPH.
  
  
  RESULTS
  The lack of experience of the proceduralist and a vaginal delivery are two risk factors that increase the risk of the patient developing a PDPH. The use of intrathecal catheters for the prevention of a headache is not of value, although an intrathecal catheter may prove to be the best method for providing analgesia for the patient. When performing an epidural blood patch, the optimal amount of blood is 20  ml, as long as the patient does not develop the symptoms of back pain or leg pain during the injection.
  
  
  CONCLUSIONS
  Many practitioners do not practice an evidence-based approach to the management of unintentional dural puncture and PDPH. Written institutional protocols are important to insure that patients receive the optimal care.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. gaiserr@uphs.upenn.edu
authors.forename: Robert R
authors.initials: RR
authors.lastname: Gaiser
mesh_terms: D000776:Anesthesiology; D017217:Blood Patch, Epidural / Q000009:adverse effects; D002404:Catheterization; D006801:Humans; D007278:Injections, Spinal; D010820:Physicians; D051299:Post-Dural Puncture Headache / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome