How Common Are Post-Dural Puncture Headaches in Children?

Discussion Post-dural puncture headache or spinal headache as they are often called, are headaches that occur within 7 days of a lumbar puncture and remit within 14 days of the lumbar puncture. They begin or worsen within 15 minutes of being in an upright position and improve or stop within 30 minutes of lying down. The headaches are described as a throbbing, dull and severe pain worse mainly in the occipital area, but can occur with radiation to the eyes, forehead or neck. Nausea, emesis, stiff neck, and visual or auditory changes may also occur. Most spinal headaches occur within 1-2 days of the lumbar puncture and spontaneously resolve after 5 days of headache (range 1-12 days). The etiology is unknown but it is thought that the lumbar puncture allows a small cerebrospinal fluid leak to occur causing intracranial hypotension, downward sagging of the brain and subsequent pulling on the pain sensitive meninges and large blood vessels. Lumbar puncture techniques which may decrease the risk of spinal headaches include using a small gauge, non-cutting needle, orienting the bevel or opening of the needle parallel to the longitudinal dural fibers and replacement of the stylet before removing the needle. Treatment usually begins with 1-2 days of supportive therapy including hydration, analgesics and bed rest. Medical treatment may include oral or IV caffeine. An epidural blood patch may also be attempted where ~10-15 ml of autologous blood is placed into the epidural space as clo...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news