The problem of post-spinal headache.

Headache is the most common complication of spinal anaesthesia. Although it is usually harmless it can, however, be so distressing to the patient that the fear of this unpredictable drawback may make many anaesthetists reluctant to use this simple anaesthetic technique. Although it is difficult to predict which patients will get post-spinal headache (PSH), we fortunately know some groups of patients who are more susceptible to PSH than others. They include young patients, female patients, patients with a history of travel sickness, patients with previous PSH, patients with an asthenic constitution and patients who have a minor operation with prompt discharge. The use of a thin needle (25-26 G) reduces the occurrence of PSH. Hydration during the operation day does not prevent PSH, nor does recumbency of 24 hours. The results are contradictory when a prophylactic epidural blood patch is used to prevent PSH. Although PSH usually ceases spontaneously within 1-4 days, treatment with an epidural blood patch is indicated if PSH is severe or affects the time of discharge. The presence of this complication must be recognised, should be avoided as far as possible and treated when necessary, but it certainly does not prevent the use of spinal anaesthesia.