Priya Gauthama1, Aditi Kelkar1, Siti M A Basar2, G Niraj3. 1. Consultants in Anaesthesia, Department of Anaesthesia & Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK. 2. Specialist Trainee in Anaesthesia, Department of Anaesthesia & Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK. 3. Consultant in Pain Medicine, Department of Anaesthesia & Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Abstract
OBJECTIVE: The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16-gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. BACKGROUND: Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self-limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. METHODS: Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow-up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. RESULTS: Over an 18-month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow-up. Of the 39 patients who completed follow-up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre-existing headache. CONCLUSION: Post dural puncture headache from an accidental dural puncture can no longer be considered a self-limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.
OBJECTIVE: The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16-gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. BACKGROUND: Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self-limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. METHODS: Prospective longitudinal service evaluation in obstetricpatients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow-up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. RESULTS: Over an 18-month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow-up. Of the 39 patients who completed follow-up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre-existing headache. CONCLUSION: Post dural puncture headache from an accidental dural puncture can no longer be considered a self-limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.