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

¹ Erasmus MC University Medical Centre, Rotterdam, Netherlands
² St. Franciscus General Hospital, Rotterdam, Netherlands

^* To whom correspondence should be addressed. E-mail: f.vankooten{at}erasmusmc.nl.

Accepted 8 July 2007

	Abstract

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, of 24 hours to 1 week duration, to receive EDBP (n=19) or conservative treatment (n=23). The primary endpoint was any headache at 24 hours after the start of treatment. Secondary endpoints were presence and severity of headache after one week. Stratified Mantel-Haenzel analysis were 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 hours after 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 3 (16%) patients allocated EDBP and 18 (86%) allocated 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 were not recovered at day 7 it was classified as moderate or severe. Adjustments for confounders did not affect these results.

Conclusions: EDBP is an effective treatment of 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.

Keywords: epidural bloodpatch, post dural puncture headache

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