• Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). (wikipedia.org)
  • PDPH is a common side effect of lumbar puncture and spinal anesthesia. (wikipedia.org)
  • PDPH is estimated to occur in between 0.1% and 36% people following dural puncture. (wikipedia.org)
  • PDPH typically occurs hours to days after puncture and presents with symptoms such as headache (which is mostly bi-frontal or occipital) and nausea that typically worsen when the patient assumes an upright posture. (wikipedia.org)
  • However, the evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache is moderate-quality and further research should be done. (wikipedia.org)
  • PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia. (wikipedia.org)
  • Background Post dural puncture headache (PDPH) is an iatrogenic cause of patient morbidity in pain management after spinal or epidural anaesthesia, as well as after diagnostic lumbar puncture. (utoledo.edu)
  • To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. (bvsalud.org)
  • Postdural puncture headache (PDPH) is a common complication following spinal anaesthesia for Caesarean section (CS). (journalajmah.com)
  • The study aimed to investigate the incidence and factors predisposing patients to PDPH after a dural puncture during a planned Caesarean section under spinal anaesthesia at Thika Level 5 Hospital, Kenya. (journalajmah.com)
  • Patient factors (age, BMI, bed rest, and previous history of PDPH), healthcare provider factors (qualification, experience, and the number of dural punctures), and equipment factors (size, design, and spinal needle orientation) were evaluated to determine predisposing factors for PDPH. (journalajmah.com)
  • Kassa A, Beyen T, Zenu Z. Post dural puncture headache (PDPH) and associated factors after spinal anaesthesia among patients in the university of Gondar referral and teaching hospital, Gondar, North West Ethiopia. (journalajmah.com)
  • Although placing an epidural catheter can be technically challenging in obese patients, the incidence of PDPH following dural puncture is decreased. (proprofs.com)
  • Post-dural puncture headache (PDPH) is one of the most frequent complications of neuraxial anesthesia and analgesia. (annexpublishers.co)
  • Incidence and risk factors of postdural puncture headache: Prospective cohort study design. (journalajmah.com)
  • To compare the ease of use of atraumatic needles with standard needles for diagnostic lumbar puncture and the incidence of headache after their use. (bmj.com)
  • The primary end point was intention to treat analysis of incidence of moderate to severe headache, assessed at one week by telephone interview. (bmj.com)
  • Secondary end points were incidence of headache at one week analysed by needle type, ease of use by operator according to a visual analogue scale, incidence of backache, and failure rate of puncture. (bmj.com)
  • Higher body mass index was associated with an increased failure rate with atraumatic needles, but the reduced incidence of headache was maintained. (bmj.com)
  • Atraumatic needles significantly reduced the incidence of moderate to severe headache and the need for medical interventions after diagnostic lumbar punctures, but they were associated with a higher failure rate than standard needles. (bmj.com)
  • 4 5 Atraumatic ("blunt") needles have been in clinical use since the 1950s, principally in anaesthetic practice, where there is substantial evidence of a reduced incidence of headache and other neurological complications after their use. (bmj.com)
  • The incidence of headache after spinal anaesthesia is typically half that after diagnostic lumbar puncture. (bmj.com)
  • We aimed to compare the incidence of headache with atraumatic and standard needles and to evaluate technical difficulties. (bmj.com)
  • Data suggest an inverse linear relation between needle gauge and headache incidence, and some authors recommend using a 22-gauge needle regardless of what size needle is supplied with the kit. (medscape.com)
  • Postdural-puncture headache incidence dropped significantly from 11.0% in the conventional needle group to 4.2% in the atraumatic group. (medscape.com)
  • Lumbar puncture success on the first attempt, failure rate, average number of attempts, and incidence of traumatic tap and backache were similar with the two needle types. (medscape.com)
  • it has not been studied for accidental dural puncture with a large bore needle. (uky.edu)
  • Easier identification of the epidural space is essential to reducing the number of epidural attempts and risk of accidental dural puncture. (milestonescientific.com)
  • As reported in the article, accidental dural puncture is particularly troublesome in the obstetric population as more than half of all patients who experience accidental dural puncture with epidural needles may eventually develop a post-dural puncture headache 1 . (milestonescientific.com)
  • Headache due to a reduced volume of cerebrospinal fluid and reduced pressure complicates a substantial proportion of lumbar punctures. (bmj.com)
  • The answer to the question, 'Are atraumatic needles better for lumbar punctures? (medscape.com)
  • Standardised protocol for lumbar puncture with 20 gauge atraumatic or standard needles. (bmj.com)
  • Spinal anaesthesia and myelography differ from diagnostic lumbar puncture because smaller gauge needles are used, smaller volumes of cerebrospinal fluid are removed, and other fluids can be introduced. (bmj.com)
  • 2 6 Despite evidence that relevant physical characteristics of atraumatic needles, such as flow rates, are comparable to those of standard needles, 6 there are limited data on their benefit in diagnostic lumbar puncture. (bmj.com)
  • 7-9 The Cochrane Collaboration has identified only two methodologically adequate studies of atraumatic needles for diagnostic lumbar puncture (C Sudlow, personal communication). (bmj.com)
  • NEW YORK (Reuters Health) - Atraumatic lumbar puncture needles are safe and effective, and they cause fewer postdural-puncture headaches and returns to the hospital for additional treatment, according to a systematic review and meta-analysis. (medscape.com)
  • As they report in The Lancet, online December 6, Dr. Almenawer and colleagues conducted a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles versus conventional needles. (medscape.com)
  • The researchers searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomized controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication. (medscape.com)
  • PURPOSE OF REVIEW: Postdural puncture headache remains the most frequent complication of neuraxial anesthesia. (uky.edu)
  • Especially the frequency of post-lumbar puncture headache will decrease, and the number of hospital readmissions or epidural blood patches for this complication will be strongly reduced," added Dr. Brouwer, who co-wrote an editorial about the study. (medscape.com)
  • Iatrogenic meningitis is a well-documented complication of lumbar puncture and carries an estimated mortality of ~35% extrapolated from a US data review ( 8 ). (cdc.gov)
  • 1-3 In the 1920s Greene hypothesised that complications could be reduced by using a smaller, tapered needle with a blunt tip, which would separate rather than cut dural fibres and thus reduce fluid leakage. (bmj.com)
  • This should change clinical practice and result in fewer patients with lumbar puncture complications. (medscape.com)
  • the patient showed no signs of complications immediately post-procedure and was discharged after 4 hours of observation. (cdc.gov)
  • It can occur following uncomplicated spinal anesthesia as well as unintended dural puncture during epidural anesthesia. (uky.edu)
  • The most promising is an intrathecal catheter as it avoids further dural puncture and seals the hole during the time it is in place, decreasing cerebrospinal fluid loss. (uky.edu)
  • We excluded patients with a history of chronic headache requiring analgesics and those with known or suspected idiopathic intracranial hypertension or other causes of an increased cerebrospinal fluid pressure. (bmj.com)
  • Lumbar puncture is a procedure that is often performed in the emergency department to obtain information about the cerebrospinal fluid (CSF). (medscape.com)
  • Isolated disk edema (eg, caused by optic neuritis or ischemic optic neuropathy) without the retinal findings indicative of elevated cerebrospinal fluid pressure is not considered papilledema (unless the intracranial pressure is elevated on concurrent lumbar puncture). (msdmanuals.com)
  • 116 patients requiring elective diagnostic lumbar puncture. (bmj.com)
  • Previous studies of diagnostic lumbar puncture have potentially been confounded by comparing different needle gauges, failing to define the operators' previous experience or the length of follow up, and not addressing technical difficulties. (bmj.com)
  • We considered as eligible for our study all patients attending the investigation ward of a regional neurology unit for elective diagnostic lumbar puncture between September 1998 and February 1999. (bmj.com)
  • Most cases occur after catheter insertion or injection into the intrathecal space, but infection related to diagnostic lumbar puncture is less common. (cdc.gov)
  • Lumbar puncture should be performed only after a neurologic examination but should never delay potentially life-saving interventions, such as the administration of antibiotics and steroids to patients with suspected bacterial meningitis. (medscape.com)
  • Neuroimaging is not necessary in patients with a history of recurrent migraine headaches and a normal neurologic examination. (medscape.com)
  • The patient came to the emergency department within 18 hours of the procedure after onset of confusion, severe headache, neck pain, nausea, vomiting, and fever. (cdc.gov)
  • Lumbar puncture is an extremely common procedure, and the strong results from this study call for switching the type of needle. (medscape.com)
  • Patients may have symptoms of increased intracranial pressure, such as headache or nausea and vomiting. (msdmanuals.com)
  • Don't perform neuroimaging studies in patients with stable headaches that meet criteria for migraine. (medscape.com)
  • Subgroup analyses of postdural-puncture headache showed no interactions between needle type and patient sex, age, position, bed rest after puncture, needle gauge, indication for lumbar puncture, use of intravenous fluid, or clinician specialty. (medscape.com)
  • Conclusion We successfully treated the post dural puncture headache and avoided the risk of viral seeding of the meninges by using a fibrin sealant. (utoledo.edu)
  • Risk factors of post-dural puncture headache receiving a blood-patch in the obstetric patient. (annexpublishers.co)
  • The smaller the needle used for the lumbar puncture, the lower the risk that the patient will experience a post-lumbar puncture headache. (medscape.com)
  • citation needed] Although in very rare cases the headache may present immediately after a puncture, this is almost always due to another cause such as increased intracranial pressure and requires immediate attention. (wikipedia.org)
  • p class=\'abstract\'>Migraine headaches are among the most prevalent and disabling pain conditions worldwide. (stanford.edu)
  • Migraine is a complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms-collectively known as an aura-that arise most often before the head pain but that may occur during or afterward (see the image below). (medscape.com)
  • Selection of laboratory and/or imaging studies to rule out conditions other than migraine headache is determined by the individual presentation (eg, erythrocyte sedimentation rate and C-reactive protein levels may be appropriate to exclude temporal/giant cell arteritis). (medscape.com)
  • The American Headache Society released a list of 5 commonly performed tests or procedures that are not always necessary in the treatment of migraine and headache, as part of the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign. (medscape.com)
  • They excluded randomized trials in which no dural puncture was performed (epidural injections) and those without a conventional needle control group. (medscape.com)
  • The headache usually occurs 24-48 hours after puncture but may occur as many as 12 days after. (wikipedia.org)
  • This patient reported that these visual auras preceded her headache by 20-30 minutes. (medscape.com)
  • Compliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits. (cms.gov)
  • Diagnosis is by ophthalmoscopy with further tests, usually brain imaging and sometimes subsequent lumbar puncture, to determine cause. (msdmanuals.com)
  • My current research interests involve novel treatment paradigms for challenging pain problems such as orofacial pain, trigeminal neuralgia and low pressure headaches. (stanford.edu)
  • Don't perform computed tomography imaging for headache when magnetic resonance imaging is available, except in emergency settings. (medscape.com)
  • Dr. Barad is a board-certified Neurologist, Headache and Pain physician. (stanford.edu)
  • She has collaborated in creating a cross-disciplinary headache center and is the co-director of the Stanford Orofacial Pain Program. (stanford.edu)