Post-dural puncture headache: pathogenesis, prevention and treatment.

Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid (CSF). In the last 50 yr, the development of fine-gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache.

[1]  J. Gormley.  Treatment of postspinal headache , 1960 .

[2]  J. Eldor.  OPIATE TREATMENT OF POST DURAL , 1995, Acta anaesthesiologica Scandinavica.

[3]  D. Levy,et al.  Exacerbation of postdural puncture headache after epidural blood patch , 1994 .

[4]  J. S. McDonald,et al.  Acute subdural hematoma--an unusual sequela to lumbar puncture. , 1979, Anesthesiology.

[5]  B. Leighton,et al.  Needle bevel direction and headache after inadvertent dural puncture. , 1989, Anesthesiology.

[6]  J. H. Hansen,et al.  DDAVP, a synthetic analogue of vasopressin, in prevention of headache after lumbar puncture and lumbar pneumoencephalography , 1979, Acta neurologica Scandinavica.

[7]  B. R. Fink,et al.  Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. , 1989 .

[8]  W. Henderson,et al.  A RANDOMIZED, DOUBLE‐BLIND CLINICAL TRIAL COMPARING THE 22 VERSUS 26 GAUGE NEEDLE IN THE PRODUCTION OF THE POST‐LUMBAR PUNCTURE SYNDROME IN NORMAL INDIVIDUALS , 1972, Headache.

[9]  R. Fishman,et al.  Spontaneous intracranial hypotension , 1992, Neurology.

[10]  J. Barrios-Alarcon,et al.  Relief of Post-Lumbar Puncture Headache with Epidural Dextran 40: A Preliminary Report , 1989, Regional Anesthesia & Pain Medicine.

[11]  C. Hodgson,et al.  The use of sumatriptan in the treatment of postdural puncture headache. , 1997, Anaesthesia.

[12]  C. MacArthur,et al.  Investigation of long term problems after obstetric epidural anaesthesia. , 1992, BMJ.

[13]  D. Levy,et al.  Exacerbation of post-dural puncture headache after epidural blood patch. , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[14]  E. C. Weir.  The sharp end of the dural puncture , 2000, BMJ : British Medical Journal.

[15]  J. Barcia,et al.  The Effect of Fibrin Glue Patch in an In vitro Model of Postdural Puncture Leakage , 1998, Anesthesia and analgesia.

[16]  E. Crosby,et al.  North American Survey of the Management of Dural Puncture Occurring During Labour Epidural Analgesia , 1998 .

[17]  D. Amar,et al.  Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia , 1994, Acta Anaesthesiologica Scandinavica.

[18]  H. Greene.  LUMBAR PUNCTURE AND THE PREVENTION OF POSTPUNCTURE HEADACHE , 1926 .

[19]  S. Eggert,et al.  Subarachnoid haemorrhage following spinal anaesthesia in an obstetric patient. , 2001, British journal of anaesthesia.

[20]  B. Scheithauer,et al.  Meningeal biopsy in intracranial hypotension , 1995, Neurology.

[21]  R. Hopf,et al.  Convulsive Seizures Following Subdural Application of Fibrin Sealant Containing Tranexamic Acid in a Rat Model , 2000, Neurosurgery.

[22]  C. Johnson,et al.  Epidural blood patch for Jehovah's Witness patient. , 1993, Anesthesia and analgesia.

[23]  K. Muir,et al.  Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture , 2000, BMJ : British Medical Journal.

[24]  K. Drasner,et al.  Transient Neurologic Symptoms after Spinal Anesthesia: An Epidemiologic Study of 1,863 Patients , 1998, Anesthesiology.

[25]  H. Flaatten,et al.  Postoperative headache in young patients after spinal anaesthesia , 1987, Anaesthesia.

[26]  H. Schaefer,et al.  Spinal anaesthesia with 29 gauge Quincke point needles and post dural puncture headache in 2,378 patients , 1994, Acta anaesthesiologica Scandinavica.

[27]  R. H. Cruickshank,et al.  Fluid flow through dural puncture sites , 1989, Anaesthesia.

[28]  P. Glass,et al.  Arm pain as an unusual presentation of postdural puncture intracranial hypotension. , 2000, Anesthesia and analgesia.

[29]  M. Wendt,et al.  In Vitro Investigation of Cerebrospinal Fluid Leakage After Dural Puncture with Various Spinal Needles , 1998, Anesthesia and analgesia.

[30]  R. Dripps,et al.  Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). , 1956, Journal of the American Medical Association.

[31]  D. Yealy,et al.  Post-dural-puncture headache: characteristics, management, and prevention. , 1993, Annals of emergency medicine.

[32]  T. Brandt,et al.  Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients , 1998, Journal of Neurology.

[33]  E G Knox,et al.  Accidental dural puncture in obstetric patients and long term symptoms. , 1993 .

[34]  M. Serpell,et al.  Choosing the best needle for diagnostic lumbar puncture , 1996, Neurology.

[35]  P. Gutterman,et al.  Prophylaxis of postmyelogram headaches. , 1978, Journal of neurosurgery.

[36]  T. Wisborg,et al.  Postdural puncture headache A comparison between 26‐ and 29‐gauge needles in young patients , 1989, Anaesthesia.

[37]  Hinnerk F. W. Wulf,et al.  The Centennial of Spinal Anesthesia , 1998, Anesthesiology.

[38]  P. Peyton,et al.  Complications of Continuous Spinal Anaesthesia , 1992, Anaesthesia and intensive care.

[39]  J. Møller,et al.  Incidence and Prediction of Postdural Puncture Headache A Prospective Study of 1021 Spinal Anesthesias , 1990, Anesthesia and analgesia.

[40]  J. Usubiaga,et al.  Effect of Saline Injecrtions on: EPIDURAL and SUBARACHNOID SPACE PRESSURES and RELATION TO POSTSPINAL ANESTHESIA HEADACHE , 1967, Anesthesia and analgesia.

[41]  W. Wahle,et al.  Epidural Injection of Autologous Blood For Postlumbar‐Puncture Headache: II. Additional Clinical Experiences and Laboratory Investigation , 1972, Anesthesia and analgesia.

[42]  B. Collier.  Treatment for post dural puncture headache. , 1994, British journal of anaesthesia.

[43]  J. de Andrés,et al.  An In Vitro Study of Dural Lesions Produced by 25-Gauge Quincke and Whitacre Needles Evaluated by Scanning Electron Microscopy , 2000, Regional Anesthesia & Pain Medicine.

[44]  F. Valldeoriola,et al.  Unilateral trigeminal and facial nerve palsies associated with epidural analgesia in labour , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[45]  P. White,et al.  A Microscopic Analysis of Cut-Bevel Versus Pencil-Point Spinal Needles , 1997, Anesthesia and analgesia.

[46]  C. Leicht,et al.  Postpartum seizure after epidural blood patch and intravenous caffeine sodium benzoate. , 1989, Anesthesiology.

[47]  D. Dutton.  A ‘postspinal headache’ associated with incidental intracranial pathology , 1991, Anaesthesia.

[48]  M. Frumin.  Spinal Anesthesia Using a 32-gauge Needle , 1969, Anesthesiology.

[49]  C. Clark,et al.  Intraocular Haemorrhage After Epidural Injection , 1961, British medical journal.

[50]  Shiv k. Sharma,et al.  Comparison of 26-Gauge Atraucan and 25-Gauge Whitacre Needles: Insertion Characteristics and Complications , 1996 .

[51]  S. Roberts,et al.  Meningitis after obstetric spinal anaesthesia , 1990, Anaesthesia.

[52]  B. Dunbar,et al.  Epidural Injections of Autologous Blood for Postlumbar‐Puncture Headache , 1970, Anesthesia and Analgesia.

[53]  J. Katz.  Fatal Brain Lesion Following Spinal Anesthesia , 1981, Regional Anesthesia & Pain Medicine.

[54]  J. Aldrete.  Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran , 1994, Headache.

[55]  M. R. Patel,et al.  CT-guided percutaneous fibrin glue therapy of cerebrospinal fluid leaks in the spine after surgery. , 2000, AJR. American journal of roentgenology.

[56]  O. Heldaas,et al.  Frequency and severity of headache after lumbar myelography using a 25-gauge pencil-point (Whitacre) spinal needle , 1995, Neuroradiology.

[57]  M. Shafei,et al.  Prevention of headache consequent upon dural puncture in obstetric patient , 1975, Anaesthesia.

[58]  H. Aken,et al.  A century of regional analgesia in obstetrics. , 2000, Anesthesia and analgesia.

[59]  A. Jackson,et al.  Does a bloody tap prevent postdural puncture headache? , 1993, Anaesthesia.

[60]  N. R. Connelly,et al.  Sumatriptan in Patients With Postdural Puncture Headache , 2000, Headache.

[61]  L. Fagraeus,et al.  Intravenous caffeine for postdural puncture headache. , 1986, Anesthesia and analgesia.

[62]  James Duffin,et al.  Dural Tissue Trauma and Cerebrospinal Fluid Leak after Epidural Needle Puncture: Effect of Needle Design, Angle, and Bevel Orientation , 2003, Anesthesiology.

[63]  J. de Andrés,et al.  [Analysis of the external and internal surface of human dura mater with scanning electron microscopy]. , 1996, Revista espanola de anestesiologia y reanimacion.

[64]  J. Sprigge,et al.  Unintentional Dural Puncture: A Survey of Recognition and Management , 1988 .

[65]  W. Parris.  Use of epidural blood patch in treating chronic headache: Report of six cases , 1987, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[66]  E. McGrady,et al.  'Spinal’headache — with no headache , 1991, Anaesthesia.

[67]  T. Jack.  Post‐partum intracranial subdural haematoma , 1979, Anaesthesia.

[68]  H. Kokki,et al.  Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children , 2000, Acta anaesthesiologica Scandinavica.

[69]  C. Marescaux,et al.  [Bilateral subdural hematoma following epidural anesthesia]. , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[70]  L. Naul,et al.  Postpartum dural venous sinus thrombosis after postdural puncture headache and epidural blood patch. , 1997, Anesthesiology.

[71]  J. Geurts,et al.  Post‐dural puncture headache in young patients. A comparative study between the use of 0.52 mm (25‐gauge) and 0.33 mm (29‐gauge) spinal needles , 1990, Acta anaesthesiologica Scandinavica.

[72]  M. Gomori,et al.  Nerve root inflammation demonstrated by magnetic resonance imaging in a patient with transient neurologic symptoms after intrathecal injection of lidocaine. , 2002, Anesthesiology.

[73]  R. Wadhwa,et al.  Regional Analgesia Following Epidural Blood Patch , 1975, Anesthesia and analgesia.

[74]  A. Rosenbaum,et al.  Magnetic Resonance Imaging of Cerebrospinal Fluid Leak and Tamponade Effect of Blood Patch in Postdural Puncture Headache , 1997, Anesthesia and analgesia.

[75]  Comparison of epidural saline placement and epidural blood placement in the treatment of post-lumbar-puncture headache. , 1979, Anesthesiology.

[76]  M. A. Cook,et al.  Epidural Blood Patch: A Rapid Coagulation Response , 1990 .

[77]  M. Burmeister,et al.  Comparison of Continuous Spinal with Combined Spinal-Epidural Anesthesia Using Plain Bupivacaine 0.5% in Trauma Patients , 1997, Anesthesia and analgesia.

[78]  A. Jackson,et al.  Magnetic resonance imaging of extradural blood patches: appearances from 30 min to 18 h. , 1993, British journal of anaesthesia.

[79]  J. Brimacombe,et al.  Epidural blood patch in the Jehovah's Witness. , 1994, Anaesthesia and intensive care.

[80]  R. J. Whitacre,et al.  Pencil-point needle in prevention of postspinal headache. , 1951, Journal of the American Medical Association.

[81]  A. Borgeat,et al.  Spontaneous movement, propofol and dopamine receptors. , 1997, Anaesthesia.

[82]  S. Cotev,et al.  Epidural morphine injections for the treatment of postspinal headache , 1990, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[83]  K. Klose,et al.  Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. , 1985, Anesthesiology.

[84]  N. Barbaro,et al.  Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression , 1998, Neurology.

[85]  K. Lech,et al.  Grading of severity of postdural puncture headache after 27‐gauge Quincke and Whitacre needles , 1997, Acta anaesthesiologica Scandinavica.

[86]  M. Vallejo,et al.  Postdural Puncture Headache: A Randomized Comparison of Five Spinal Needles in Obstetric Patients , 2000, Anesthesia and analgesia.

[87]  R. Dripps,et al.  Long-term follow-up of patients who received 10,098 spinal anesthetics. IV. Neurological disease incident to traumatic lumbar puncture during spinal anesthesia. , 1960, Journal of the American Medical Association.

[88]  Kinyon Ge.  Epidural blood patch for post-lumbar puncture headache. , 1980 .

[89]  J. Pearce.  Walter Essex Wynter, Quincke, and lumbar puncture. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[90]  D. Amar,et al.  Extradural blood patch for post-lumbar puncture headaches in cancer patients , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[91]  B. Condon,et al.  Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[92]  D. Turnbull,et al.  Headache after diagnostic lumbar puncture. Doctors given intrathecal methotrexate had headache when 20 gauge standard needle was used. , 2001 .

[93]  J. Sprigge,et al.  Dural puncture: the patients' perspective A patient survey of cases at a DGH maternity unit 1983–1993 , 1996, Acta anaesthesiologica Scandinavica.

[94]  J. Tinker,et al.  Clinical dilemma: a patient with postdural puncture headache and acute leukemia. , 1999, Anesthesia and analgesia.

[95]  E. Abouleish,et al.  Long‐Term Follow‐Up of Epidural Blood Patch , 1975, Anesthesia and analgesia.

[96]  Hoskin Mf.  Spinal anaesthesia--the current trend towards narrow gauge atraumatic (pencil point) needles. Case reports and review. , 1998 .

[97]  M. Corbey,et al.  Classification and severity of postdural puncture headache , 1993, Anaesthesia.

[98]  D. Moir.  Recent advances in pain relief in childbirth. II. Regional anaesthesia. , 1971, British journal of anaesthesia.

[99]  J. S. Crawford.  Experiences with epidural blood patch , 1980, Anaesthesia.

[100]  R. Stevens,et al.  Successful treatment of dural puncture headache with epidural saline infusion after failure of epidural blood patch , 1988, Acta anaesthesiologica Scandinavica.

[101]  J. Diaz.  Permanent paraparesis and cauda equina syndrome after epidural blood patch for postdural puncture headache. , 2002, Anesthesiology.

[102]  Aldrete Ja,et al.  Intrathecal hematoma and arachnoiditis after prophylactic blood patch through a catheter. , 1997 .

[103]  F. Reynolds.  Dural puncture and headache. , 1993, BMJ.

[104]  E. Lehtonen,et al.  Deformed spinal needle tips and associated dural perforations examined by scanning electron microscopy , 1996, Acta anaesthesiologica Scandinavica.

[105]  D. Selander,et al.  Postdural puncture headache after continuous spinal anesthesia. , 1987, Anesthesia and analgesia.

[106]  P. Novack,et al.  Clinical implications of recent studies on cerebral circulation of man. , 1954, A M A Archives of Neurology & Psychiatry.

[107]  Post-spinal headache or intracranial tumor after obstetric anesthesia. , 1979, Anesthesiology.

[108]  H. Pajunk,et al.  [An "atraumatic" universal needle for single-shot regional anesthesia: clinical results and a 6 year trial in over 30,000 regional anesthesias]. , 1987, Regional-Anaesthesie.

[109]  Nathaniel Katz,et al.  Post-dural puncture thoracic pain without headache: relief with epidural blood patch , 1995, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[110]  L. Carrie.  Whitacre and pencil‐point spinal needles: some points to consider , 1990, Anaesthesia.

[111]  M. W. Galbert,et al.  Epidural Injection of Autologous Blood For Postlumbar‐Puncture Headache: II. Additional Clinical Experiences and Laboratory Investigation , 1972, Anesthesia and analgesia.

[112]  C. Baysinger,et al.  The successful treatment of dural puncture headache after failed epidural blood patch. , 1986, Anesthesia and analgesia.

[113]  T. Brandt,et al.  Should one reinsert the stylet during lumbar puncture? , 1997, The New England journal of medicine.

[114]  J. S. Crawford.  The prevention of headache consequent upon dural puncture. , 1972, British journal of anaesthesia.

[115]  F. Reynolds,et al.  Lumbar puncture and headache. "Atraumatic needle" is a better term than "blunt needle". , 1998, BMJ.

[116]  R. Carbajal,et al.  [Post-lumbar puncture headache in children. Treatment with epidural autologous blood (blood patch)]. , 1998, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[117]  S. Yentis.  Lumbar puncture and headache. Replacing the stylet before withdrawing the needle may help to prevent headache. , 1998, BMJ.

[118]  A. Cunningham,et al.  Pituitary apoplexy after spinal anaesthesia. , 1998, British journal of anaesthesia.

[119]  A. J. Bart,et al.  Comparison of epidural saline placement and epidural blood placement in the treatment of post-lumbar-puncture headache. , 1978, Anesthesiology.

[120]  J. Ulrich,et al.  Anatomical re-evaluation of lumbar dura mater with regard to postspinal headache. Effect of dural puncture. , 1989, Anaesthesia.

[121]  R. Carbajal,et al.  Céphalées post-ponction lombaire chez l'enfant. Intérêt de l'injection péridurale de sang autologue (blood patch) , 1998 .

[122]  P. Diemunsch,et al.  Hématome sous durai bilatéral après analgesie péridurale , 1998 .

[123]  P. Mushlin,et al.  Effects of Oral Caffeine on Postdural Puncture Headache: A Double‐Blind, Placebo‐Controlled Trial , 1990, Anesthesia and analgesia.

[124]  S. Hameroff,et al.  Spinal subdural epiarachnoid hematoma: a complication of a novel epidural blood patch technique. , 1980, Anesthesia and analgesia.

[125]  D. Burn,et al.  Is bed rest useful after diagnostic lumbar puncture? , 1992, Postgraduate medical journal.

[126]  J. Pfitzner,et al.  Restricted spread of analgesia following epidural blood patch , 1983 .

[127]  E. Ringelstein,et al.  Epidural fibrin clot for the prevention of post-lumbar puncture headache: a new method with risks. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[128]  B. R. Fink,et al.  Orientation of Fibers in Human Dorsal Lumbar Dura Mater in Relation to Lumbar Puncture , 1989, Anesthesia and analgesia.

[129]  S. Halpern,et al.  Postdural Puncture Headache and Spinal Needle Design: Metaanalyses , 1994, Anesthesiology.

[130]  J. Ashley,et al.  The Sprotte Needle and Post Dural Puncture Headache following Caesarean Section , 1993 .

[131]  C. Lander,et al.  HISTOPATHOLOGIC CONSEQUENCES OF EPIDURAL BLOOD PATCH AND EPIDURALLY ADMINISTERED DEXTRAN 40 , 1988 .

[132]  H. R. Tyler,et al.  Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache. Case report. , 1982, Journal of neurosurgery.

[133]  M. Douglas,et al.  Comparison of the 25-gauge Whitacre with the 24-gauge Sprotte spinal needle for elective Caesarean section: cost implications , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[134]  C. Handler,et al.  Posture and Lumbar Puncture Headache: A Controlled Trial in 50 Patients , 1982, Journal of the Royal Society of Medicine.

[135]  J. Sprung,et al.  PDPH in Obstetric Anesthesia: Comparison of 24-Gauge Sprotte and 25-Gauge Quincke Needles and Effect of Subarachnoid Administration of Fentanyl , 1992, Regional Anesthesia & Pain Medicine.

[136]  P. Gorelick,et al.  James Leonard Corning and the early history of spinal puncture , 1987, Neurology.

[137]  H. Holder.  REACTIONS AFTER SPINAL ANESTHESIA , 1944 .

[138]  L. Krueger,et al.  Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients. , 1992, Anesthesiology.

[139]  L. S. Reisner,et al.  The frequency of postdural puncture headache in obstetric patients: a prospective study comparing the 24-gauge versus the 22-gauge Sprotte needle. , 1994, Journal of clinical anesthesia.

[140]  I. Grant,et al.  Epidural Blood Patch in the HIV-positive Patient Review of Clinical Experience , 1992 .

[141]  L. Kaukinen,et al.  Fatal Brain Lesion Following Spinal Anaesthesia: Report of a Case , 1981, Acta anaesthesiologica Scandinavica.

[142]  P. Klepstad.  Relief of postural post dural puncture headache by an epidural blood patch 12 months after dural puncture , 1999, Acta anaesthesiologica Scandinavica.

[143]  R. Haschke,et al.  Spinal needle determinants of rate of transdural fluid leak. , 1989 .

[144]  E. Abouleish,et al.  Long-term follow-up of epidural blood patch. , 1975 .

[145]  E. Eckstein,et al.  Anatomic and biomechanical properties of human lumbar dura mater. , 1993, Anesthesia and analgesia.

[146]  B. Lämmle,et al.  Dural puncture and activated protein C resistance: risk factors for cerebral venous sinus thrombosis , 1997, Journal of neurology, neurosurgery, and psychiatry.

[147]  J. Aldrete,et al.  TREATMENT OF POST‐SPINAL HEADACHE WITH EPIDURAL DEXTRAN 40 , 1987 .

[148]  A. C. Primavesi.  ? Postpartum Headache after Epidural Blood Patch: Investigation and Diagnosis , 2000 .

[149]  G. Stein,et al.  Headaches after childbirth. , 1984, Acta neurologica Scandinavica.

[150]  J. Hannerz,et al.  MR Imaging with Gadolinium in Patients with and without Post-Lumbar Puncture Headache , 1999, Acta radiologica.

[151]  P. Barker.  Headache after dural puncture , 1989, Anaesthesia.

[152]  E. Carrero,et al.  Prevention of Post Dural Puncture Headache with Epidural-administered Dextran 40 , 1992, Regional Anesthesia & Pain Medicine.

[153]  W. Tourtellotte,et al.  Post-lumbar puncture headaches , 1964 .

[154]  J. A. Lee.  Arthur Edward James Barker 1850‐1916 , 1979, Anaesthesia.

[155]  P. Singh,et al.  Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. , 1994, Anesthesia and analgesia.

[156]  B. E. Shapiro,et al.  Unintentional dural puncture and prophylactic epidural blood patch in obstetrics. , 1989, Anesthesia and analgesia.

[157]  E. Keener.  An experimental study of reactions of the dura mater to wounding and loss of substance. , 1959, Journal of neurosurgery.

[158]  J. Kroin,et al.  The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model. , 2002 .

[159]  G. Marx.  The First Spinal Anesthesia: Who Deserves the Laurels? , 1994, Regional Anesthesia & Pain Medicine.

[160]  T. Andersen,et al.  Repetitive hearing loss following dural puncture treated with autologous epidural blood patch , 1995, Acta anaesthesiologica Scandinavica.

[161]  R. J. Jones.  The Role of Recumbency in the Prevention and Treatment of Postspinal Headache , 1974, Anesthesia and analgesia.

[162]  J. Hamza,et al.  Treatment of postdural puncture headaches with colloid solutions: an alternative to epidural blood patch. , 1999, Anesthesia and analgesia.