A post-dural puncture headache (PDPH) is characterised by postural worsening in upright position. The most effective definitive treatment after failed conservative management is:
- A IV caffeine 500 mg bolus
- B Epidural saline infusion at 30 mL/hr for 24 hours
- C Sumatriptan 6 mg subcutaneous injection
- D Epidural blood patch with 15–20 mL of autologous blood ✓
Explanation
PDPH results from CSF leakage through the dural puncture, causing intracranial hypotension and traction on pain-sensitive structures. The epidural blood patch (EBP) — injecting 15–20 mL of autologous blood into the epidural space at or one level below the puncture site — acts by direct tamponade and volume replacement of CSF. Success rate is approximately 90% after a single patch, >95% after a second patch. Caffeine provides temporary relief by cerebral vasoconstriction and CSF production stimulation but is not definitive. Epidural saline provides temporary volume replacement. Sumatriptan is not the treatment of choice.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.