Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
Headache. 2024 Sep;64(8):1015-1026. doi: 10.1111/head.14790. Epub 2024 Jul 16.
Post-dural puncture headache (PDPH) is a frequent complication following lumbar puncture, epidural analgesia, or neuraxial anesthesia. The International Classification of Headache Disorders, third edition categorizes PDPH as a self-limiting condition; however, emerging evidence, including our findings, suggests that PDPH can have a prolonged course, challenging this traditional view.
To elucidate the diagnostic characteristics and treatment outcomes of persistent PDPH (pPDPH), offering insights into its demographic profiles and diagnostic features.
We executed an anonymous, web-based survey targeting individuals aged ≥18 years diagnosed with or suspected of having pPDPH. Recruitment occurred through self-help groups on Facebook. The survey comprised questions regarding diagnostic procedures, treatment regimens, outcomes, and healthcare consultation.
The survey achieved a response rate of 179/347 (51.6%) individuals completing the questionnaire. Cerebrospinal fluid (CSF) leaks were confirmed in nine of 179 (5.0%) cases. Signs of intracranial hypotension without a CSF leak were observed in 70/179 (39.1%) individuals. All participants underwent magnetic resonance imaging scans of the brain and spine, with computed tomography myelography performed in 113/179 (63.1%) cases. Medications, including analgesics, theophylline, and gabapentin, provided minimal short-term relief. Epidural blood patch treatments resulted in slight-to-moderate short-term improvement in 136/179 (76.0%), significant improvement in 22/179 (12.3%), and complete effectiveness in eight of 179 (4.5%) individuals. For long-term outcomes, slight-to-moderate improvement was reported by 118/179 (66.0%) individuals. Surgical interventions were carried out in 42/179 (23.5%) patients, revealing pseudomeningoceles intraoperatively in 20/42 (47.6%) individuals. After surgery, 21/42 (50.0%) of the participants experienced slight-to-moderate improvement, 12/42 (28.6%) showed more pronounced improvement, and five of the 42 (11.9%) achieved complete effectiveness.
This study underscores the complexities of managing pPDPH. The delay in diagnosis can impact the effectiveness of treatments, including epidural blood patch and surgical interventions, resulting in ongoing symptoms. This underscores the importance of tailored and adaptable treatment strategies. The findings advocate for additional research to deepen the understanding of pPDPH and improve long-term patient outcomes.
腰椎穿刺后头痛（PDPH）是腰椎穿刺、硬膜外镇痛或脊麻后常见的并发症。《国际头痛疾病分类》第三版将 PDPH 归类为自限性疾病；然而，包括我们的研究结果在内的新证据表明，PDPH 可能会持续很长时间，这对传统观点提出了挑战。
阐明持续性 PDPH（pPDPH）的诊断特征和治疗结果，深入了解其人口统计学特征和诊断特征。
我们对年龄≥18 岁的被诊断为或疑似患有 pPDPH 的个体进行了匿名的基于网络的调查。通过 Facebook 上的自助小组进行招募。调查包括诊断程序、治疗方案、结果和医疗咨询的问题。
该调查的应答率为 179/347（51.6%）完成问卷的个人。在 179 例患者中，有 9 例（5.0%）经证实存在脑脊液漏。70/179（39.1%）例患者存在无脑脊液漏的颅内低血压迹象。所有参与者均接受了脑部和脊柱磁共振成像扫描，113/179（63.1%）例患者进行了计算机断层脊髓造影术。包括镇痛药、茶碱和加巴喷丁在内的药物仅在短期提供了轻微至中度的缓解。硬膜外血贴治疗在 136/179（76.0%）例患者中导致轻度至中度的短期改善，在 22/179（12.3%）例患者中导致显著改善，在 8/179（4.5%）例患者中导致完全有效。对于长期结果，118/179（66.0%）例患者报告有轻度至中度改善。42/179（23.5%）例患者进行了手术干预，20/42（47.6%）例患者术中发现假性脑脊膜膨出。手术后，21/42（50.0%）例参与者有轻度至中度改善，12/42（28.6%）例有更明显的改善，5/42（11.9%）例完全有效。
这项研究强调了管理 pPDPH 的复杂性。诊断的延迟会影响硬膜外血贴和手术干预等治疗的效果，导致持续的症状。这强调了制定个体化和适应性治疗策略的重要性。研究结果主张进行更多的研究，以加深对 pPDPH 的理解并改善长期患者预后。
