The epidural blood patch: are more than two ever necessary?

Headache is a protean disorder with both extraand intracranial etiologies possible. Postlumbar puncture headache (PLPH) has been described extensively and may be complicated by headache of other etiologies. Since introduced by Gormley in 1960, the epidural blood patch (EBP) has become an accepted means of therapy for PLPH (1). The rare need for more than two properly performed epidural blood patches attests to its effectiveness (2). We present a report of a patient with headache of more than one etiology who required a total of four epidural blood patches for resolution of her PLPH.