100 Headache Medicine, v.3, n.3, p.100, Jul./Aug./Sep. 2012

Post-dural puncture headache: clinical characteristics

and diagnostic criteria (abstract)

Cefaleia pós-punção dural: características clínicas e critérios diagnósticos (resumo)

Background and objectives:Background and objectives:

Background and objectives: The diagnostic criteria

for post-dural puncture headache (PDPH) of the International

Classification of Headache Disorders (ICHD-II, 2004) state

that postural headache appears not later than the fifth day

after the puncture and disappears spontaneously within a

week, or within 48 hours after treatment with an epidural

blood patch. The criteria also necessarily include at least

one of the following symptoms: neck stiffness, tinnitus, hearing

loss, photophobia, and nausea. In this study, we evaluated

the clinical features of PDPH and the validity of diagnostic

criteria (ICHD-II, 2004).

MethodsMethods

Methods: Over one year, 640 patients (332 women and

308 men) aged between 8 and 65 years underwent spinal

anesthesia, with Quincke needles, 25G (n = 239) and 27G

(n = 401). The onset of postural headache, i.e., when the

pain worsens or appears after sitting or standing, was

investigated through daily visits to patients and/or phone

contact for seven days after anesthesia. Among the patients

who had PDPH the following characteristics were evaluated:

(1) the latency period between the dural puncture and the

onset of headache, (2) the location and intensity of pain, 3)

accompanying symptoms, and (4) the duration. The

procedures for descriptive statistics were used measures of

central tendency: mean, dispersion (standard deviation and

variation amplitude) and frequency distribution. The chi-square

test was applied and considered statistically significant when

p <0.05. This study was approved by the Ethics Committee in

Research and informed consent was obtained from patients

or their legal guardians.

Results:Results:

Results: 48 patients (7.5%) had postural headache. The

latency period ranged from 6 to 72 hours (24.0 ± 16.8 hours)

and the duration from 3 to 15 days (4±2 days). Pain was

reported in the following regions: occipital, 26 (54%); frontal,

19 (40%); and holocranial, 3 (6%). In 85% of patients the

Jane Auxiliadora Amorim

Universidade Federal de Pernambuco – UFPE. Pós-graduação de Neuropsiquiatria e

Ciências do Comportamento (área de concentração: Neurociências). PhD Thesis. 2012.

Orientador: Marcelo Moraes Valença

Amorim JA. Post-dural puncture headache: clinical characteristics and diagnostic criteria (abstract).

Headache Medicine. 2012;3(3):100

Correspondence

Jane Auxiliadora AmorimJane Auxiliadora Amorim

Jane Auxiliadora Amorim

janemarcos22@superig.com.br

THESESTHESES

THESES

intensity of the headache was moderate or severe. 14 of the

48 patients (29.2%) had no accompanynig symptoms.

Conclusions:Conclusions:

Conclusions: Our results are not in consistent with the

ICHD-II diagnostic criteria; we thus suggest a number of

changes in the diagnostic criteria.