RESEARCH PAPERS

Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial

F van Kooten¹, R Oedit², S L M Bakker³, D W J Dippel¹

¹ Department of Neurology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
² Department of Neurology, Ruwaard van Putten General Hospital, Spijkenisse, The Netherlands
³ Department of Neurology, St Franciscus General Hospital, Rotterdam, The Netherlands

Dr F van Kooten, Department of Neurology, Erasmus Medical Centre, PO Box 2040 3000 CA Rotterdam, The Netherlands; f.vankooten{at}erasmusmc.nl

Objectives: To determine the efficacy of epidural blood patch (EDBP) for the treatment of post dural puncture headache (PDPH).

Methods: We randomised 42 patients who presented with PDPH, lasting 24 h to 1 week, to receive EDBP (n = 19) or conservative treatment (n = 23). The primary end point was any headache at 24 h after the start of treatment. Secondary end points were presence and severity of headache after 1 week. Stratified Mantel–Haenzel analysis was used to adjust for confounders.

Results: Two patients refused to participate directly after randomisation and allocation to conservative treatment. They were excluded from the study. At 24 h after the start of treatment, headache was present in 11 (58%) patients allocated to EDBP and in 19 (90%) patients allocated to conservative treatment (RR 0.64, 95% CI 0.43 to 0.96). At day 7, headache was present in three (16%) patients allocated to EDBP and in 18 (86%) allocated to conservative treatment (RR 0.18, 95% CI 0.06 to 0.53). Headache was mild in all three EDBP patients, but in 10 of 18 conservatively treated patients who had not recovered by day 7 it was classified as moderate or severe. Adjustments for confounders did not affect these results.

Conclusions: EDBP is an effective treatment for PDPH. It offers complete resolution of symptoms in a large proportion of patients. In the remaining patients, it reduces headache severity and allows them to return to their everyday activities.

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Historical corrections to van Kooten at al.

Brian E Harrington

JNNP Online, 11 Jun 2008 [Full text]