title: Comparison of cosyntropin versus caffeine for post-dural puncture headaches: A randomized double-blind trial.
abstract: BACKGROUND
  Cosyntropin has been reported to be effective in the treatment of post-dural puncture headaches, but there is a lack of data on its effectiveness. We compared the efficacy of cosyntropin with that of caffeine in the treatment of post-dural puncture headaches.
  
  
  METHODS
  We performed an interim analysis of a prospective, double blinded, trial of adult patients presenting to the emergency department with a post-dural puncture headache. Patients were randomized to receive either intravenous caffeine or intravenous cosyntropin. Values on a 100-mm visual analog scale (VAS) were recorded at 0, 60, and 120 minutes to assess pain. Rescue therapy was documented on the study data forms. Its effectiveness was determined by the need for this therapy.
  
  
  RESULTS
  Thirty-seven patients were included and four patients were excluded from the analysis because of protocol violations or incomplete data. Analysis was based on intention-to-treat. Caffeine was 80% (95% CI 60-100%) effective and cosyntropin was 56% (95% CI 33-79%) effective in treating post-dural puncture headaches. The group's VAS scores at 0, 60, and 120 minutes were 80 mm, 41 mm, 31 mm for caffeine and 80 mm, 40 mm, 33 mm for cosyntropin, respectively (P=0.66).
  
  
  CONCLUSIONS
  Caffeine was not more effective than cosyntropin in treating patients with post-dural puncture headaches, and there was no difference in the degree of pain relief on VAS assessment.
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Wesley
authors.initials: W
authors.lastname: Zeger
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Younggren
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Lynette
authors.initials: L
authors.lastname: Smith
keywords: Caffeine; Cosyntropin; Lumber; Post-dural puncture headaches