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Dias R, Ferreira C, Mendes ÂB, Marvão J, Lages N, Machado H. Postpartum headache after epidural anaesthesia: Who to blame? Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:531-536. [PMID: 34836583 DOI: 10.1016/j.redare.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/17/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH). CASE DESCRIPTION 37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy. DISCUSSION There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap. CONCLUSION Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.
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Affiliation(s)
- R Dias
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
| | - C Ferreira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Â B Mendes
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - J Marvão
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - N Lages
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - H Machado
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Dias R, Ferreira C, Mendes ÂB, Marvão J, Lages N, Machado H. Postpartum headache after epidural anaesthesia: Who to blame? Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(20)30227-9. [PMID: 33516566 DOI: 10.1016/j.redar.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH). CASE DESCRIPTION 37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy. DISCUSSION There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap. CONCLUSION Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.
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Affiliation(s)
- R Dias
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
| | - C Ferreira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Â B Mendes
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - J Marvão
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - N Lages
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - H Machado
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Didier-Laurent A, De Gaalon S, Ferhat S, Mihailescu SD, Maltete D, Laplaud D, Lefaucheur R, Guegan-Massardier E, Grangeon L. Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study. Rev Neurol (Paris) 2020; 177:676-682. [PMID: 33069377 DOI: 10.1016/j.neurol.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Occurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence. METHODS We conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria. RESULTS Seventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH. CONCLUSION PDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.
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Affiliation(s)
- A Didier-Laurent
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France.
| | - S De Gaalon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - S Ferhat
- Department of Neurology, Evreux Hospital, Evreux, France
| | - S-D Mihailescu
- Department of Biostatistics, Rouen University Hospital, 76031 Rouen, France
| | - D Maltete
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | - D Laplaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | | | - L Grangeon
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France.
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Urits I, Cai V, Aner M, Simopoulos T, Orhurhu V, Nagda J, Viswanath O, Kaye AD, Hess PE, Gill J. Post Dural Puncture Headache, Managed with Epidural Blood Patch, Is Associated with Subsequent Chronic Low Back Pain in Patients: a Pilot Study. Curr Pain Headache Rep 2020; 24:1. [PMID: 31916041 DOI: 10.1007/s11916-020-0834-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH. RECENT FINDINGS The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP. A total of 146 patients were contacted and completed a survey questionnaire via telephone. The EBP group was found to be more likely to have chronic LBP (percentage difference 20% [95% CI 6-33%], RR 2.6 [95% CI 1.3-5.2]) and also LBP < 6 (percentage difference 24% [95% CI 9- 37%], RR 2.3 [95% CI 1.3-4.1]). There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Our findings suggest that PDPH treated with an EBP is associated with an increased prevalence of subsequent low back pain in parturients. The findings of this pilot study should spur further prospective research into identifying potential associations between DP, EBP, and chronic low back pain.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Viet Cai
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Musa Aner
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Thomas Simopoulos
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jyotsna Nagda
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Alan D Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Philip E Hess
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jatinder Gill
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. [PMID: 31179908 PMCID: PMC6135040 DOI: 10.1186/s12245-018-0199-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background Intracranial subdural hematoma occurring as a result of a procedure that causes a puncture of the spinal dura mater is extremely rare, with less than 100 cases reported. Often, this condition is initially misdiagnosed and treated as a post dural puncture headache. Case presentation A woman presented to our emergency department complaining of a headache 4 days after receiving epidural anesthesia during uncomplicated childbirth. The headache’s characteristics were consistent with a post dural puncture headache, and the patient was initially treated as such. Computed tomography later revealed the presence of bilateral intracranial subdural hematomas. In light of the patient’s clinical status, treatment involved cautious observation only. Repeat imaging revealed spontaneous resolution of the hematomas, and the patient had a benign clinical course. Conclusions Headaches are common in the postpartum period, often after receiving epidural or spinal anesthesia. While exceptionally rare, intracranial subdural hematoma may occur as a complication of any procedure that results in spinal dural puncture. The possibility of this potentially life-threatening complication must be kept in mind when evaluating these patients.
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Affiliation(s)
- Victor Szeto
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA
| | - Justin Kosirog
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA.
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Ergün U, Ünal-Artık HA, İnan LE, Yoldaş T. Intravenous theophylline rapidly decreases post-lumbar puncture headaches. Acta Neurol Belg 2016; 116:337-9. [PMID: 26563407 DOI: 10.1007/s13760-015-0562-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 01/03/2023]
Abstract
When managing therapy for the post-lumbar puncture headaches (PLPHs), an efficacious, fast-acting, practical and safe method is preferred. Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches. The aim of this study was to highlight the brief initial time for a remarkable decrease of PLPH pain levels after the administration of IV theophylline infusion. We observed that IV theophylline infusion has a rapid and marked effect on decreasing pain in PLPHs. At 30 min of theophylline infusion, mean VAS levels were decreased by 47.1 % and at 60 min of infusion, the decrease of pain was 61.9 %. We conclude that IV theophylline infusion is a rapidly effective, noninvasive, practical and low-cost way to treat PLPHs. To the best of our knowledge, this is the first study to highlight both the efficacy and the speed of the effect of pain relief in PLPHs.
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