Synacthen Depot for the treatment of postdural puncture headache. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Theophylline relieves headache following lumbar puncture. Placebo-controlled, double-blind pilot study. Sumatriptan in patients with postdural puncture headache. Evaluation of intravenous hydrocortisone in reducing headache after spinal anesthesia: a double blind controlled clinical study [corrected].
We conducted a prospective, randomised, double-blind trial to study the effect of Synacthen Depot in 18 parturients with postdural puncture headache following deliberate or accidental dural puncture. Women were randomly allocated to receive either Synacthen Depot 1 mg (1 ml) or 0.9% saline 1 ml intramuscularly. Using a 10-cm visual analogue scale, severity of headache was measured before and at intervals until 48 h after injection. There was no difference in the severity of headache or requirement for epidural blood patch. We conclude that there is no advantage to the use of Synacthen Depot 1 mg for the treatment of postdural puncture headache. Forty postpartum patients with postdural puncture headache (PDPH) were randomly assigned to receive oral caffeine (300 mg) or a placebo. Intensity of headache, quantitated using a visual analogue pain scale (VAS), was assessed immediately before drug administration and 4 and 24 h later. Relief of PDPH measured as delta VAS (initial VAS - VAS at 4 h) was significantly better in the caffeine than in the placebo group (P = 0.014). Six patients (30%) whose PDPH was relieved by caffeine at 4 h had recurrence of symptoms the following day. Our study demonstrates that caffeine administered orally provides relief, albeit if sometimes transient, from PDPH with minimal side effects. In a study of 11 patients with typical headache following diagnostic lumbar puncture the effect of peroral treatment with theophylline (Euphyllin retard) was compared with that of placebo. When the headache was provoked by orthostatic strain, the six patients in the verum group showed significantly less pain (mean pain score: 16 +/- 3.91) than the five patients in the placebo group (mean pain score: 28 +/- 4.73). This beneficial effect of theophylline on post-puncture headache was subsequently confirmed by open observations of ten additional patients. In view of the small sample size our results should be considered preliminary. Nevertheless, they suggest that additional trials on the benefit of methylxanthines in the treatment of post-puncture headache are called for. To determine the efficacy of sumatriptan in the management of patients presenting for an epidural blood patch for the management of postdural puncture headache.
                Postdural puncture headache can be quite severe, requiring invasive therapy (ie, epidural blood patch). Sumatriptan has been used successfully in patients with postdural puncture headache, however, its use has not been investigated in a controlled fashion.
                Ten patients with postdural puncture headache presenting for an epidural blood patch were given either saline or sumatriptan subcutaneously. The severity of the headache was evaluated at baseline and 1 hour following injection. If the headache remained severe, an epidural blood patch was performed.
                Only one patient in each group received relief from the injection.
                We do not recommend sumatriptan in patients who have exhausted conservative management of postdural puncture headache. Headache after spinal anesthesia is a common complication is patients undergoing this procedure. In this study we evaluated the efficacy of intravenous hydrocortisone in the treatment of headache after spinal anesthesia in women who have undergone cesarean section.
                Sixty patients with headache after spinal anesthesia were included. Patients randomly allocated into two groups, 30 patients received only conventional therapy (complete bed rest, hydration, acetaminophen and pethidine). Other 30 patients received conventional therapy plus intravenous hydrocortisone (200 mg first, then 100 mg TID for 48 hours). Mean (+/- SD) of headache intensity at 0, 6, 24, and 48 hours after beginning of treatment was measured using visual analog scale.
                There was no significant difference in headache intensity between two groups before beginning of treatment. After 6 hours, the mean of headache intensity in 30 patients treated conventionally was 6.63 (+/- 1.35) while it was 2.77 (+/- 1.07) in other patients received intravenous hydrocortisone too (p <0.001). After 24 hours, mean headache intensity was 3.87 (+/- 1.63) in conventionally treated group versus 0.73 (+/- 0.74) in hydrocortisone group (p <0.001). After 48 hours, mean headache intensity was 1.87 (+/- 0.93) in conventionally treated group versus 0.63 (+/- 0.61) in hydrocortisone group (p = 0.001).
                This study showed the therapeutic effects of intravenous hydrocortisone in reducing headache after spinal anesthesia in women who underwent cesarean section. Its mechanism of action is yet to be determined.