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REPLY

Vancouver, British Columbia

I agree with Dr. Wong’s observations on the lack of information relating to the details regarding postdural puncture headache (PDPH) in clinical reports despite the extensive amount of literature on this topic. At the time of the meta-analysis, 12 reports had been published on PDPH with Whitacre 25-gauge needles in the obstetrical population. Of the 6,366 patients studied, 103 suffered PDPHs yielding a pooled estimate of 2.2% (adjusted for within-study and between-study variances).¹ Of the 103 PDPHs, the headache was described as mild, moderate, and severe in 16, 21, and seven patients respectively.² The intensity of the remaining 59 headaches was not reported. Seven studies reported the duration of follow-up (median 5 days, range 1 to 42 days).² Onset of PDPH, reported in only one study, ranged from one to five days post-dural puncture with 8 mild, 11 moderate, and 6 severe PDPHs.² Duration, also reported in only one study, was one day in one PDPH of unknown intensity.² Neither study reported duration of follow-up. Two studies described the interventions used to treat PDPH.²

Over 100 years of observational and experimental data have been published on PDPH. The International Headache Society has published diagnostic criteria for this complication³ and several authors have proposed definitions for severity.^4,5 Large observational studies are still needed to obtain sufficient numbers of PDPH. Researchers need to report the diagnostic criteria, onset, severity, duration, and therapeutic interventions used. Only then will clinicians be able to determine whether PDPH from a small gauge pencil-point spinal needle, such as the Whitacre 25-gauge, is self-limiting within a short period of time.

References

1 Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anesth 2003; 50: 460–9.[Abstract/Free Full Text]

2 Choi PT. Best evidence in anesthesia: an evaluation of the information on post-dural puncture headache in the obstetrical population [M.Sc. Thesis]. Hamilton: McMaster University; 2001.

3 Anonymous. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Diagnostic criteria 7.2.1. Post-lumbar puncture headache. Headache Classification Committee of the International Headache Society. Cephalalgia 1988; 8(Suppl 7): 1–96.

4 Lybecker H, Djernes M, Schmidt JF. Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand 1995; 39: 605–12.[Medline]

5 Corbey MP, Bach AB, Lech K, Frorup AM. Grading of severity of postdural puncture headache after 27-gauge Quincke and Whitacre needles. Acta Anaesthesiol Scand 1997; 41: 779–84.[Medline]

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