Post-dural puncture headache is typically ?
Ans is 'c' i.e. Bifrontal or occipital Characteristics of post lumbar puncture Headache Cause - There is loss of C.S.F which decreases the brains suppoive cushion so that when a patient is upright there is dilatation and tension placed on brain's anchoring structures and the pain sensitive dural sinuses, resulting in pain. Nature - Usually a dull ache but may be throbbing Location - Occipito frontal * Accompanying symptoms -Nausea, stiff neck, blurred vision, photophobia, tinnitus and veigo Onset - Pain usually begins within 48hrs., but may be delayed for upto 12 days. Precipitating factors It is dramatically positional, it begins when the patient sits or stands upright Also worsened by head shaking or jugular venous compression Relief is obtained on reclining or with abdominal compression Treatment Post-LP headache usually resolves without specific treatment, and care is largely suppoive with oral analgesics and antiemetics. Patients may obtain relief by lying in a comfoable position. For some patients beverages with caffeine can provide temporary pain relief. For patients with persistent pain, - Treatment with I.V. caffeine may be effective. Epidural blood patch : an epidural blood patch accomplished by injection of 15m1. of autologus whole blood is almost successful in those who do not respond to caffeine.
A result of leakage of blood into the epidural space
Worse when lying down than in sitting position
Bifrontal or occipital
Seen within 4 hours of dural puncture