Case Study: Post Dural Headache

Dear Editor, Post Dural Puncture Headache (PDPH) is a known complication after accidental dural puncture during epidural anaesthesia, subarachnoid block, myelography and diagnostic lumbar puncture. It’s incidence in totality ranges from 0.16-1.3%(depending upon the needle size and type).[1] Epidural blood patch has remained the gold standard of treatment, while including other modalities like hydration, use of abdominal binder, caffeine and desmopressin. Sumatriptan, a 5-hydroxytryptamine-1D receptor (5HT1D) agonist causing cerebral vasoconstriction, used in management of migraine, could have a role in the treatment of PDPH. Its use has been limited to case reports, with variable results. We present two cases at our institute where use of Sumatriptan was beneficial in the treatment of the same. In the first case, a 44-year-old male, underwent orchidectomy and partial scrotectomy under spinal anaesthesia using a 23G Quincke's needle. The patient complained of occipital headache and neckache, postural in nature, 48 hours after surgery. He was advised to have plenty of oral fluids along with Tab. Paracetamol 650mg …show more content…
[3] J S Sprigge, found a beneficial effect of Sumatriptan in an obstetric patient who had history of dural puncture for 3 times. [4] Another group of researchers found that only 1out of 5 patients had symptomatic relief. [5] Most of the research has been done with intra-venous or intra-muscular Sumatriptan, while we administered it orally. We were able to successfully achieve more than 90% pain relief in the first patient; however, the second patient had only 50% pain relief. PDPH is very distressing for the patient, and Sumatriptan could have a beneficial role in the non-invasive management of PDPH. It can be tried in patients with no significant cardiac