What works for the management of PDPH; is the current evidence enough?

Post Dural Puncture Headache (PDPH) is apparently not an uncommon occurrence and in most cases need seriousattention. Conservative, supportive non-pharmacological management to interventional invasive and pharmacologicaltreatment of PDPH are reported in the literature. The PDPH treatment strategies can be divided into symptom managementand mechanism directed therapies, both of which complement each other. Supportive management for symptom reliefincludes soft pain killers, non-steroidal anti-inflammatory drugs, oral hydration and caffeinated drinks. If PDPH doesnot resolve then epidural blood patch is considered a definitive intervention. Novel pharmacological therapies testedand reported include use of triptans. Over two decades, sumatriptan has been used in a staggered manner and somereports of its success and lack of effectiveness appeared in the literature. In this issue Riaz A. et al have reported thefirst successful use of Zolmitriptan for PDPH. Although recent Cochrane review is not supportive of triptan use inPDPH but the review could not include Zolmitriptan therapy in PDPH since the original research article in this issue isthe first reported use of it. This editorial view discusses the PDPH prevention, current therapeutic strategies, and novelpharmacological management with triptans. Future research and reporting is encouraged for PDPH management andthe clinicians might welcome ‘whatever works strategy’, if supported by clinical reasoning, scientific evidence and in practicesafely without causing any harm.