PDPH Overview
Definition
PDPH is a headache attributed to CSF leakage occurring within 5 days of dural puncture (intentional or unintentional).
Key features
- Postural component: Worsens within 15 minutes of sitting/standing, improves within 15 minutes of lying down
- Usually accompanied by neck stiffness and/or subjective hearing symptoms
- May persist >2 weeks despite traditional teaching
- Can occur >5 days post-procedure (especially after discharge)
High certainty
High-Risk Factors
Patient factors
- Younger age, female sex
Procedural factors
- Cutting needles > noncutting needles
- Larger needle gauge
- Multiple attempts
- Less experienced operator
Additional considerations
Moderate-Risk Factors
History of headaches (chronic, prior PDPH)
Lateral position may be protective
Signs & symptoms
Clinical Presentation
Typical symptoms
- Postural headache (but few patients had no postural component)
- Neck stiffness
- Pain in cervical/thoracic/lumbar spine
- Subjective hearing symptoms
- Visual disturbances
- Vertigo
Urgent evaluation
Red Flags - Require Neuroimaging
Immediate clinical attention required if any of the following are present.
- Non-orthostatic headache
- Onset >5 days post-procedure
- Focal neurological deficits
- Visual changes
- Altered consciousness
- Seizures
- Worsening despite EBP