Detaillierte Beitrags-Information
| Beitragstitel | Diagnostic and Therapeutic Insights in Persistent Post-Dural Puncture Headache |
|---|---|
| Beitragscode | P08 |
| Autor:innen | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract-Text |
Background: Post-dural puncture headache (PDPH) is a frequent complication following lumbar puncture, epidural analgesia, or neurosurgical interventions. The International Classification of Headache Disorders (ICDH) states that PDPH “remits spontaneously within two weeks, or after sealing of the leak with autologous epidural lumbar patch”. However, some patients experience a prolonged course challenging this traditional view. Therefore, this study aimed to elucidate diagnosis and treatment in individuals with persistent PDPH (pPDPH). Methods: We conducted a cross-sectional anonymous online survey in individuals aged 18 or older, diagnosed with, or suspected to have pPDPH via self-help groups on Facebook. The survey comprised questions about diagnostic procedures, therapeutic management, and treatment outcomes. Results: A total of 179 participants (83.2% female, mean age 39.7 years) completed the survey. All participants underwent cranial magnetic resonance imaging (MRI) and an MRI of the spine. Computed tomography (CT) myelography was performed in 63.1%. Cerebrospinal fluid (CSF) opening pressure and optic nerve sheath diameter were measured in 25.1% and 21.8%. CT cisternography and CSF scintigraphy were applied in 11.7% and 3.4%. The time lapsed since dural puncture exceeded three months in more than one third of the MRI examinations and in the vast majority of all other examinations. Diagnostic work-up revealed a CSF leak in 5%, confirmed or suggested intracranial hypotension in 39.1% and 17.9%, and showed equivocal findings or no evidence of intracranial hypotension in 5% and 31.3 %. For pharmacological treatment, caffeine, analgesics, gabapentin, antidepressants and theophylline were used by 91.1%, 79.3%, 38.0%, 34.1%, and 20.7.% Overall effectiveness was very poor. All participants underwent an epidural blood patch (EBP) and less than one quarter each received a fibrin glue patch (FBP), occipital nerve block (ONB) or surgical treatment (ST). The proportion of patients experiencing marked improvement or complete resolution of symptoms with EBP, FBP, ONB, and ST was 16.8%, 24.4%, 11.9% and 40.5% in the short-term and 6.7%, 7.3%, 2.4%, and 40.4% in the long-term. Conclusion: This study underscores the challenges of managing pPDPH specifying the delay in and the limitations of diagnostic procedures, the poor effectiveness of therapeutic interventions, and the need to add “persistent postdural headache” in ICHD. |