Treatment of post dural puncture headache: To patch or not to patch?

摘要

In the present issue of Scandinavian Journal of Pain, Dr Joseph Atallah and his co-workers from Toledo, Ohio, USA, report a case where post-dural puncture headache (PDPH) was successfully treated using epidural injection of a fibrin sealant product as an alternative to epidural autologous blood patch (EBP) in a patient with hepatitis C and HIV. These have traditionally been treatment with autologous EBP, or the "wait and see" strategy, combined with analgesics, coffee or cola-drinks. Often the headache will gradually be alleviated even with the conservative strategy, and there are certain risks associated with any invasive procedure, even EBP. Are there situations when it is beneficial or even necessary to administer the EBP, or seek alternatives such as the fibrin sealant to stop the leakage of the cerebrospinal fluid?