Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial
- 1Department of Neurology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- 2Department of Neurology, Ruwaard van Putten General Hospital, Spijkenisse, The Netherlands
- 3Department 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;
- Received 17 April 2007
- Revised 6 July 2007
- Accepted 8 July 2007
- Published Online First 17 July 2007
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.
Funding: This study was supported by The Netherlands Headache Society.
Competing interests: None.
Ethics approval: The study was approved by the local medical ethics committee and review board.