Atypical headache following dural puncture in obstetrics.

Détails

ID Serval
serval:BIB_943EA0EE3917
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Atypical headache following dural puncture in obstetrics.
Périodique
International Journal of Obstetric Anesthesia
Auteur(s)
Loures V., Savoldelli G., Kern K., Haller G.
ISSN
1532-3374 (Electronic)
ISSN-L
0959-289X
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
23
Numéro
3
Pages
246-252
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish PDF: Original Article
Résumé
BACKGROUND: In obstetrics, post-dural puncture headache is a well-recognised complication. Typical symptoms include fronto-temporal or occipital headache, worsening with ambulation and improving in the decubitus position. Occasionally, patients present with non-postural headache, although relatively little is known about this atypical presentation. The purpose of this study was to determine the incidence, associated signs and risk factors for this atypical manifestation of post-dural puncture headache.
METHODS: We analysed a series of 27 064 parturients having a neuraxial procedure between January 2001 and December 2010. Using data from electronic anaesthesia patient records, medical charts and a postpartum quality audit, we identified all parturients with atypical post-dural puncture headache. We assessed the incidence and used uni- and multivariate analysis to identify associated risk factors.
RESULTS: Amongst 142 parturients with post-dural puncture headache, eight (5.6%, 95% CI 1.7-9.4%) had atypical non-postural headache. Associated symptoms were stiffness and pain in the cervical, thoracic or lumbar vertebral area, visual disturbances and vertigo. Significant risk factors for developing atypical signs were previous migraine, odds ratio 6.1 (95% CI 1.2-28.7), a more cephalad level of needle insertion, odds ratio 17.2 (95% CI 1.4-210.1) and identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter, odds ratio 5.5 (95% CI 1.2-24.4). Following multivariate analysis, recognition of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter was the most significant predictor of non-orthostatic postdural puncture headache.
CONCLUSION: Anaesthetists should be aware of this atypical clinical presentation, particularly if there is a past history of migraine, a more cephalad level of needle insertion or identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter.
Pubmed
Web of science
Création de la notice
05/09/2014 18:11
Dernière modification de la notice
03/03/2018 19:37
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