Postpunktionskopfschmerz

Post-dural puncture headache (PDPH) is a frequent yet often underestimated complication of neuraxial anesthesia. The presumed mechanism involves cerebrospinal fluid loss due to accidental dural perforation, leading to intracranial hypotension and a secondary compensatory vasodilation. Meningeal irritation and neuroinflammatory processes also contribute to the complex pathophysiology. The main symptom is a severe orthostatic headache with pain exacerbation in an upright posture. This can be accompanied by neck stiffness, tinnitus, visual and other neurological disorders. Patient-specific risk factors are young age, female sex and a positive history of headaches and anesthesia-related factors include puncture needle size and design. The epidural blood patch (EBP) is the current gold standard for treatment. The occasionally considerable patient suffering and optimization of the outcomes necessitate a critical analysis of the treatment options.