title: Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan: a retrospective analytical study.
abstract: OBJECTIVE
  Postdural puncture headache (PDPH) is one of the most recognized complications after spinal anesthesia in women undergoing cesarean delivery. This study aimed to investigate the incidence of PDPH and its associated risk factors in women undergoing cesarean delivery in Jordan.
  
  
  METHODS
  This study included all women who underwent cesarean delivery at King Abdullah University Hospital in Jordan during 2015. Patient characteristics including age, weight, occurrence of PDPH, needle type, repeated puncture attempt, history of spinal anesthesia and PDPH, presence of tension headache, preeclampsia, migraine, sinusitis, and caffeine withdrawal were collated from hospital records. Statistical analyses were performed to assess the association of these characteristics with PDPH.
  
  
  RESULTS
  The study cohort consisted of 680 women. Among these, only 43 (6.3%) had developed PDPH. The only factors that showed significant association (P<0.01) with PDPH were repeated puncture attempt and presence of tension headache. The repeated puncture attempt increased the risk of PDPH 2.55-fold, while presence of tension headache increased the risk 4.60-fold. Furthermore, the use of the traumatic 27 G Spinostar needle increased the risk of repeated puncture attempt 28.45-fold (P<0.01) compared with the use of the pencil-point 25 G Whitacre needle.
  
  
  CONCLUSIONS
  The major risk factors associated with the incidence of PDPH in women undergoing cesarean delivery in Jordan are repeated puncture attempt and presence of tension headache. The use of the pencil-point 25 G Whitacre needle is recommended since this was associated with a substantially reduced risk of repeated spinal puncture than the traumatic 27 G Spinostar needle.
authors.affiliation: Department of Anesthesia.
authors.forename: Wail N
authors.initials: WN
authors.lastname: Khraise
authors.affiliation: Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Mohammed Z
authors.initials: MZ
authors.lastname: Allouh
authors.affiliation: Department of Anesthesia.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: El-Radaideh
authors.affiliation: Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Raed S
authors.initials: RS
authors.lastname: Said
authors.affiliation: Department of Anesthesia.
authors.forename: Anas M
authors.initials: AM
authors.lastname: Al-Rusan
keywords: postdural puncture headache; postspinal puncture headache; spinal anesthesia; spinal needle