DP24: RE-EVALUATING POST-DURAL PUNCTURE HEADACHE: PROCEDURAL DETERMINANTS, MANAGEMENT STRATEGIES, AND EMERGING LONG-TERM MORBIDITY
Helena De Azeredo Miranda1; Jhon Ostanin2; Beatriz De Faria Sousa2
1Florida Atlantic University Charles E. Schmidt College of Medicine; 2Florida International University Herbert Wertheim College of Medicine
BACKGROUND: Post-dural puncture headache (PDPH) is a frequent and clinically important complication of neuraxial procedures, particularly in young and obstetric patients. Historically considered a benign, self-limited condition, emerging evidence over the past decade has demonstrated substantial variability in its incidence, a strong dependence on modifiable procedural factors, and associations with significant acute and long-term morbidity. Contemporary literature has also challenged the adequacy of conservative management alone and highlighted the need for structured prevention, treatment, and follow-up strategies to address this issue. While prior reviews have addressed aspects of PDPH, a comprehensive synthesis integrating the latest evidence on modifiable procedural factors, emerging long-term sequelae, and their implications for contemporary guidelines is lacking. This narrative review aimed to synthesize contemporary evidence (2015-2025) regarding the incidence, risk factors, prevention strategies, acute management, and long-term sequelae of PDPH in adults, with an emphasis on identifying modifiable procedural factors and clinically meaningful outcomes relevant to patient care.
METHODS: A narrative review of peer-reviewed literature published between 2015 and 2025 was conducted, focusing on adult patients who underwent lumbar puncture, spinal anesthesia, or epidural anesthesia. Sources included cohort studies, randomized controlled trials, systematic reviews, and consensus guidelines addressing PDPH epidemiology, patient- and procedure-related risk factors, preventive interventions, therapeutic strategies, and long-term outcomes. The evidence was qualitatively synthesized to provide an integrated clinical framework.
RESULTS: The reported PDPH incidence varied widely across clinical settings, ranging from <2% following optimized spinal anesthesia with small-gauge atraumatic needles to 60-80% after accidental dural puncture in obstetric patients. Younger age, female sex, pregnancy, low body mass index, and prior headache history were consistently associated with an increased risk, whereas procedural factors, particularly needle size, needle tip design, and number of puncture attempts, exerted the greatest influence. Preventive strategies centered on atraumatic needle use and optimized techniques. Epidural blood patching has demonstrated high efficacy (approximately 85-95%) for moderate-to-severe PDPH. Emerging cohort data have linked PDPH to chronic headache, persistent low back pain, and rare but serious neurological complications.
DISCUSSION: This review highlights PDPH as a clinically consequential condition with meaningful short- and long-term implications. Modifiable procedural factors represent the most effective targets for prevention, whereas timely epidural blood patching remains the cornerstone of treatment for functionally limiting symptoms. Growing evidence of chronic sequelae underscores the need for patient counseling, structured follow-up, and adherence to contemporary guideline recommendations. Further research is warranted to refine preventive strategies and to better characterize long-term outcomes.