Post-dural puncture headache (PDPH) after inadvertent dural tap in obstetric epidural anaesthesia has which characteristic feature that distinguishes it from other causes of postoperative headache?

• A Occipital location, worse at night, relieved by vomiting
• B Bilateral frontal headache with photophobia, unrelated to posture
• C Headache associated with neck stiffness and fever, suggesting meningitis
• D Postural headache worsening markedly when sitting or standing and relieved within 30 minutes of lying flat ✓

Explanation

PDPH is defined by its postural character: severe worsening within 15 minutes of sitting or standing and resolution within 30 minutes of lying flat. It results from CSF loss through the dural defect exceeding production, causing intracranial hypotension and downward traction on pain-sensitive meningeal structures. Accompanying symptoms include tinnitus, diplopia (VI nerve palsy from meningeal traction), nausea, and photophobia. Definitive treatment is an epidural blood patch (autologous blood 15–20 mL); conservative management includes bed rest, caffeine, and hydration.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.