Classification and severity of postdural puncture headache. Comparison of 26-gauge and 27-gauge Quincke needle for spinal anaesthesia in day-care surgery in patients under 45 years.

Two hundred and five patients, aged 16-45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26- or a 27-gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. The incidence of classical postdural puncture headache was 4.5% following the use of a 26-gauge needle and 8% with a 27-gauge needle (p > 0.05). A further group of patients suffering headache after dural puncture was identified, the postdural puncture-related headache. The headache and accompanying symptoms were similar to that seen with a postdural puncture headache except that it was not aggravated by posture. A system of grading the severity of both type of headache is presented and standardised criteria for the classification of postdural puncture headache are proposed.