A post-dural puncture headache (PDPH) classically differs from other headaches by which feature?

• A It is occipital in location and does not change with posture
• B It is worst in the supine position and improves on standing
• C It is associated with papilloedema and vomiting regardless of posture
• D It is bilateral, fronto-occipital, and markedly worsens within 15 minutes of assuming upright posture ✓

Explanation

The hallmark of PDPH is its postural nature: the headache appears or dramatically worsens within minutes of sitting or standing and relieves within 30 minutes of lying supine. It is typically bilateral and fronto-occipital in distribution. The mechanism is CSF leakage through the dural puncture, reducing CSF pressure in the upright position, which causes traction on pain-sensitive intracranial structures. Papilloedema is a feature of raised intracranial pressure — the opposite of what occurs in PDPH. The definitive treatment is an epidural blood patch.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.