PDPH

PDPH

http://www.acep.org/content.aspx?id=32526

frontal headache that can become generalised, can radiate to interscapular region
visual changes, cranial nerve palsy, tinnitus, photophobia
worsened by movements that increase ICP (coughing,sneezing)
worse on sitting up
Gutshe sign: firm manual p on abdomen: temporary relieve

increased risk:
female, pregnancy, pre existing headache,

small gauge, higher number- a/w less headache and hearing loss
size of needle, placement of tip, orientation of bevel (longitudinal orientation- lower risk)

cutting : quincke
pencil: whitacre, sprotte, -lower incidence of PDPH
pencil point: more trauma, more inflammation, promote healing?
- but need operator expertise

cutting 36% (22G Quincke), 3-25% (25G Quincke), whitacre 3%- randomised trial
16G tuohy 70%

operator experience and amt of fluid used-not significant\
lying supine/bedrest-not shown to be effective


MANAGEMENT:

DIFFERENTIALS:
cerebral venous sinus thrombosis,
migraine,
caffeine withdrawal