Post spinal puncture headache: diagnosis, risk factors and treatment

Abstract

Spinal anesthesia is one of the most used anesthetic techniques, having been in existence for over 100 years, and over time it has been improved by the development of a new needle design, gauge, tip shapes, as well as more precise indications and contraindications. However, even so, there are still possible complications due to this procedure, especially headache after puncture of the dura mater, and, because of that, this procedure carries with it a great increase of taboos and prejudices. Although it is clear that reducing the size of the dural perforation reduces CSF loss, thus making the incidence of headache less likely, there are many other issues to be clarified regarding the pathophysiology, treatment and prevention of post-dural puncture headache. How does needle design, size, and orientation influence CSF leakage through dural perforation? Can pharmacological methods reduce symptoms of post-dural puncture headache? Can epidural blood patch help in the treatment of post-spinal anesthesia headache? Can epidural blood patch act prophylactically? Does epidural saline solution reduce the rate of CSF loss? Thus, this article aims to answer these questions according to the most recent studies and make an objective review of post spinal anesthesia headache with an approach to pathophysiology, diagnosis, clinical scenario, risk factors, prevention and therapeutic options.