Treatment OF Post dural puncture headache (PDPH) after caesarean section: a review of clinical trial articles conducted in Iran

Document Type : Review Article

Authors

1 Assistant professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

2 Instructor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

3 Associate Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

4 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Qom University of medical sciences, Qom, Iran.

5 Associate Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

6 Assistant Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

Abstract

Introduction: Headache is one of the common problems after spinal anesthesia following cesarean surgery. Various pharmacological methods have been proposed for the treatment of headache after spinal anesthesia. This study was conducted with aim to evaluate headache after spinal anesthesia following caesarean section in the form of a narrative review of clinical trial articles conducted in Iran.
Methods: In this narrative review study, to find related studies, the Persian language databases of "SID", "Magiran" and the Google Scholar and English language databases of Scopus, PubMed, and Web of Science were searched with the keywords of PDPH, spinal anesthesia and cesarean section wiyhout time limitation.
Results: In this narrative review study, 29 articles were examined. The reviewed studies were done from 2007-2022. The investigated drugs include: Pregabalin, gabapentin, theophylline, ondansetron, aminophylline, dexamethasone, caffeine, mannitol, intravenous acetaminophen (paracetamol), normal saline, propofol and hydrocortisone. Among the investigated drugs, dexamethasone has been most effective in controlling PDPH, and then, ondansetron has been most effective in reducing and controlling PDPH.
Conclusion: The present study showed good evidence on the effectiveness of the drugs investigated in the studies. It seems that all the investigated drugs can be used as a treatment for headache (PDPH) after spinal anesthesia in cesarean section women; however, among the investigated drugs, since more studies have been performed on dexamethasone, it can be a more suitable choice for preventing headache after spinal anesthesia in cesarean section women.

Keywords


  1. Shakeri M, Shakibazade E, Arami R, Soleimani M. Cesarean delivery on maternal request in Zanjan, Iran. Life Science Journal 2013; 10(1):1308-11.
  2. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990. The Journal of the American Society of Anesthesiologists 1997; 86(2):277-84.
  3. Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis. Acta Anaesthesiologica Scandinavica 2013; 57(4):417-30.
  4. Kara I, Ciftci I, Apiliogullari S, Arun O, Duman A, Celik JB. Management of postdural puncture headache with epidural saline patch in a 10-year-old child after inguinal hernia repair: A case report. Journal of Pediatric Surgery 2012; 47(10):e55-7.
  5. Janssens E, Aerssens P, Alliët P, Gillis P, Raes M. Post-dural puncture headaches in children. A literature review. European journal of pediatrics 2003; 162(3):117-21.
  6. Basurto Ona X, Martínez García L, Solà I, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2011; (8):CD007887.
  7. Frank RL. Lumbar puncture and post-dural puncture headaches: implications for the emergency physician. J Emerg Med 2008; 35(2):149-57.
  8. Abdulla S, Abdulla W, Eckhardt R. Caudal normal saline injections for the treatment of post-dural puncture headache. Pain Physician 2011; 14(3):271-9.
  9. Fournet-Fayard A, Malinovsky JM. Post-dural puncture headache and blood-patch: theoretical and practical approach. Ann Fr Anesth Reanim 2013; 32(5): 325-38.
  10. Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post–dural puncture headache. The Journal of the American Society of Anesthesiologists 2001; 95(2):334-9.
  11. Nikooseresht M, Hajian P, Afiati-vesal T, Moradi A. Effect of prophylactic gabapentin on post-dural puncture headache in patients after cesarean section surgery. Koomesh 2022; 24(3):320-6.
  12. Shahriari A, Nataj-Majd M, Khooshideh M, Salehi-Vaziri S. The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial. Curr J Neurol 2021; 20(2):95-101.
  13. Karami T, Hoshyar H, Jafari AF. The effect of pregabalin on postdural puncture headache among patients undergoing elective cesarean section: A randomized controlled trial. Annals of Medicine and Surgery 2021; 64:102226.
  14. Gholami H, Motamed N, Hojatansari M, Hushmandpur F. Comparison the Effect of Gabapentin and Theophylline on Post Spinal Headache After Cesarean Section. Journal of Advances in Medical and Biomedical Research 2021; 29(136):251-6.
  15. Mashak B, Pouryaghobi SM, Rezaee M, Rad SS, Ataei M, Borzabadi A. Evaluation of the Effects of Magnesium Sulfate on Prevention of Post-dural-Puncture Headache in Elective Cesarean in Kamali Hospital. Electron J Gen Med 2020; 17(3):1-6.
  16. Dehghanpisheh L, Bayani S, Azemati S, Rakhshan M. The effect of intravenous administration of ondansetron compared to aminophylline on incidence and severity of post-dural puncture headache (PDPH) in cesarean section surgeries. Biomed Res 2019; 30(6):1-6.
  17. Najafi Anaraki A, Mirzaei K. Comparing the Prophylactic Effect of Pregabalin with that of Aminophylline Plus Dexamethasone on Postdural Puncture Headache after Spinal Anesthesia in Cesarean Section: A Double-Blind Controlled Randomized Clinical Trial. ISMJ 2019; 22(5):307-16.
  18. Pazoki S, Modir H, Kamali A, Zamani A, Shahidani M. Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial. Medical gas research 2018; 8(2):48-53.
  19. Shokrpour M, Homayuni S, Kamali A, Pazuki S. Comparing the prophylactic effect of ondansetron and dexamethasone in controlling headaches caused by spinal anesthesia among women candidated for caesarean A randomized controlled trial. Electronic Journal of General Medicine 2018; 15(4):6.
  20. Sabertanha A, Shakhsemampour F, Allahyari E. Evaluation the effect of dexamethasone on post-dural puncture headache in cesarean surgery. J Surg Trauma 2018; 6(1).
  21. Hasannasab B, Banihashem N, Seyfi S, Yazdanmehr M. The effect of aminophylline on prevention of post-spinal anesthesia headache in patients undergoing elective cesarean section: a randomized clinical trial. Tehran Univ Med J 2018; 76(6):396-402.
  22. Shahidani M, Pazeki S, Modir H, Kamali A, Zamani A. Effect of iv injection of two doses of ondansetron in comparison with normal saline in peventing of headaches after spinal anesthesia in pregnant women referred to Taleghani Hospital – Arak. Journal of Iranian Society Anaesthesiology and Intensive Care 2017; 38(3):63-73.
  23. Naghibi K, Moradi-Farsani D, Hirmandpour A, Forutan A. Comparison of the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section. J Isfahan Med Sch 2017; 35(424):345-50.
  24. Golfam P, Yari M, Rezaei M, Farhadi K, Mahdavi JR, Lahoorpour A. The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section. Journal of Kermanshah University of Medical Sciences 2016; 20(2):51-5.
  25. Jabalameli M, Sadat SM. The efficacy of prophylactic intravenous aminophylline, paracetamol or aminophylline and paracetamol in prevention of headache strikes due to spinal anesthesia in cesarean sections compared to the control group. J Isfahan Med Sch 2016;34(400):1144-50.
  26. Jabalameli M, Payandeh M. Comparing the Effect of Paracetamol, Dexamethasone, and Paracetamol plus Dexamethasone on Prevention of Postoperative Headache in Pregnant Women Undergoing Cesarean Section with Spinal Anesthesia. J Isfahan Med Sch 2018; 35(457):1700-6.
  27. Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. J Anesth 2015; 29(5):702-7.
  28. Ghanei M, Sahraei R, Zabetian H, Radmehr M, Jahromi AS, Ghobadifar MA, et al. Intravenous Aminophyline Prevents Post Dural Puncture Headache In Women Undergoing Cesarean Section: A Randomized Placebo-Controlled Trial. Revista Kasmera 2015; 43:305-19.
  29. Masoudifar M, Aghadavoudi O, Adib S. Effect of venous dexamethasone, oral caffeine and acetaminophen on relative frequency and intensity of postdural puncture headache after spinal anesthesia. Advanced biomedical research 2016; 5.
  30. Saghaleini SH, Ghorbanian EA. Comparison of the effect of gabapentin, pregabalin and acetaminophen in post-dural puncture headache. Iran J Obstet Gynecol Infertil 2013; 16(82):1-7.
  31. Faridi Tazeh-kand N, Eslami B, Ghorbany Marzony S, Abolhassani R, Mohammadian K. Injection of intrathecal normal saline in decreasing postdural puncture headache. Journal of anesthesia 2014; 28(2):206-9.
  32. Sadeghi SE, Nabi RM, Attari M, Zarei H, Hasan ZS, Hussain ZS. Evaluation of the effect of methylxantine derivatives on prevention of postdural puncture headache in elective cesarean section. Iranian Journal of Anesthesiology and Intensive Care 2013; 81(2):6-11.
  33. Sadeghi SE, Abdollahifard G, Nasabi NA, Mehrabi M, Safarpour AR. Effectiveness of single dose intravenous aminophylline administration on prevention of post dural puncture headache in patients who received spinal anesthesia for elective cesarean section. World J Med Sci 2012; 7(1):13-6.
  34. Hamzei A, Basiri-Moghadam M, Pasban-Noghabi S. Effect of dexamethasone on incidence of headache after spinal anesthesia in cesarean section. Saudi Med J 2012; 33(9):948-53.
  35. Yousefshahi F, Dahmardeh AR, Khajavi M, Najafi A, Khashayar P, Barkhordari K. Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial. Acta Neurologica Belgica 2012; 112(4):345-50.
  36. Manuchehrian N, Arjomandi M, Bakhshaei M, Hajian P, Alipur N, Farhanchi A. Efficacy of prophylactic intravenous dexamethasone in prevention of headache strikes due to spinal anesthesia in cesarean sections compared to the control group. Ournal of Ilam University of Medical Sciences 2012; 19(4):1-11.
  37. Motaghi K, Safari F, Khodabendelou L, Salimi A. Evaluation the efficacy of IV dexamethasone on post puncture headache incidence after cesarian section. Anesthesiology and Pain 2011; 2(2):34-40.
  38. Tavakol K, Ghaffari P, Hassanzadeh A. Study of the effect of dexamethasone and normal saline in reducing headache after spinal anesthesia in cesarean section. Armaghane danesh 2007; 12(3):87-94.
  39. Ashraf N, Sadeghi A, Azarbakht Z, Salehi S, Hamediseresht E. Hydrocortisone in post-Dora perforation headache (PDPH). Iranian Journal of Anesthesiology and Intensive Care 2007; 19(2): 415-22.
  40. Jabari Moghadam M. Comparison of the effect of gabapentin with pregabalin in post dural puncture headache. J Iran Soc Anesthesiol Intensive Care 2010; 31:1-6.
  41. Huseyinoglu U, Huseyinoglu NE, Hamurtekin E, Aygun H, Sulu B. Effect of pregabalin on post-dural-puncture headache following spinal anesthesia and lumbar puncture. Journal of Clinical Neuroscience 2011; 18(10):1365-8.
  42. El Rahmawy G, Rashwan D, Mohamed NN. The efficacy of preoperative pregabalin on reduction of the incidence and severity of postdural puncture headache after spinal anesthesia. Egyptian Journal of Anaesthesia 2013; 29(4):357-61.
  43. Lin YT, Sheen MJ, Huang ST, Horng HC, Cherng CH, Wong CS, et al. Gabapentin relieves post-dural puncture headache--a report of two cases. Acta Anaesthesiol Taiwan 2007; 45(1):47-51.
  44. Lin YT, Sheen MJ, Hung ST. Gabapentin relieves post dural puncture headache. Acta Anaesthesiol Taiwan 2007; 19(2):415-22.
  45. Ramos N, Samayoa F, Sánchez A. Cefalea post punción dural al utilizar agujas de Quincke vrs. agujas de Whitacre en pacientes obstétricas. Revista Colombiana de anestesiología 2004; 32(4):253-60.
  46. Dauri M, Faria S, Gatti A, Celidonio L, Carpenedo R, Sabato AF. Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences. Curr Drug Targets 2009; 10(8):716-33.
  47. Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet 2010; 49(10):661-9.
  48. Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Saudi Journal of Anaesthesia 2014; 8(3):374-7.
  49. Wagner Y, Storr F, Cope S. Gabapentin in the treatment of post-dural puncture headache: a case series. Anaesthesia and intensive care 2012; 40(4):714-8.
  50. Nofal WH, Mahmoud MS, Abd Al Alim AA. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?. Saudi Journal of Anaesthesia 2014; 8(3):359-63.
  51. Ibayashi S, Ngai AC, Meno JR, Winn HR. The effects of dipyridamole and theophylline on rat pial vessels during hypocarbia. J Cereb Blood Flow Metab 1988; 8(6):829-33.
  52. Schwalbe SS, Schiffmiller MW, Marx GF. Theophylline for postdural puncture headache. Anesthesiology 1991; 75(3):1082-30.
  53. Ergün U, Say B, Ozer G, Tunc T, Sen M, Tüfekcioglu S, et al. Intravenous theophylline decreases post-dural puncture headaches. J Clin Neurosci 2008; 15(10):1102-4.
  54. Mahoori AL, Hassani E, Noroozinia H, Javaheri NE, Hatami S. Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH). Middle East J Anesthesiol 2013; 22(3):289-92.
  55. Vandam LD, Dripps RD. Long-term follow-up of patients who received 10,098 spinal anesthetics: syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). Journal of the American medical association 1956; 161(7):586-91.
  56. Gyermek L. Pharmacology of serotonin as related to anesthesia. J Clin Anesth 1996; 8(5):402-25.
  57. Safarpour AR, Mehrabi M, Tarkesh F, Ashrafizadeh H, Keshtkar A, Askari H, et al. Aminophylline for Prevention and/or Treatment of Post-Dural Puncture Headache: A Systematic Review and Meta-Analysis Study Protocol. Anesthesiology and Pain Medicine 2021; 11(5).
  58. Wu C, Guan D, Ren M, Ma Z, Wan C, Cui Y, et al. Aminophylline for treatment of postdural puncture headache: A randomized clinical trial. Neurology 2018; 90(17):e1523-9.
  59. Yang CJ, Chen T, Ni X, Yu WY, Wang W. Effect of pre-administration with aminophylline on the occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia. J Int Med Res 2019; 47(1):420-6.
  60. Fenta E, Kibret S, Hunie M, Teshome D. Dexamethasone and post-dural puncture headache in women who underwent cesarean delivery under spinal anesthesia: A systemic review and meta-analysis of randomized controlled trials. Ann Med Surg (Lond) 2021; 62:104-13.
  61. Okpala BC, Eleje GU, Ikechebelu JI, Ofojebe CJ, Ejikeme TB, Nwachukwu CE, et al. A double-blind placebo controlled trial on effectiveness of prophylactic dexamethasone for preventing post-dural puncture headache after spinal anesthesia for cesarean section. J Matern Fetal Neonatal Med 2022; 35(17):3407-12.
  62. Masino S, Boison D, editors. Adenosine: a key link between metabolism and brain activity. Springer Science & Business Media; 2012.
  63. Sawynok J. Methylxanthines and pain. Handb Exp Pharmacol 2011; (200):311-29.
  64. Ragab A, Facharzt KN. Caffeine, Is it effective for prevention of postdural puncture headache in young adult patients?. Egyptian Journal of Anaesthesia 2014; 30(2):181-6.
  65. Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg 1990; 70(2):181-4.
  66. Rizvi M, Singh R, Tripathi R, Immaculate S. New approach to treat an old problem: Mannitol for post dural puncture headache!. Indian J Anaesth 2015; 59(4):260-1.
  67. Kassim DY, Esmat IM. Comparative study between hydrocortisone and mannitol in treatment of postdural puncture headache: A randomized double-blind study. Egyptian Journal of Anaesthesia 2016; 32(3):357-63.
  68. Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryngol 2008; 265(3):351-5.
  69. Bhattacharya D, Paul S, Naskar S, Mitra M, Mandal M. Comparison of the respective effects of paracetamol, pregabalin, and their combination in the treatment of postdural puncture headache following major gynecological surgery. Ain-Shams Journal of Anaesthesiology 2016; 9(3):387-92.
  70. Mitra S, Khandelwal P, Sehgal A. Diclofenac–tramadol vs. diclofenac–acetaminophen combinations for pain relief after caesarean section. Acta Anaesthesiologica Scandinavica 2012; 56(6):706-11.
  71. Parsons AA, Strijbos PJ. The neuronal versus vascular hypothesis of migraine and cortical spreading depression. Current opinion in pharmacology 2003; 3(1):73-7.
  72. Hargreaves RJ, Shepheard SL. Pathophysiology of migraine—new insights. Canadian journal of neurological sciences 1999; 26(3):12-9.
  73. Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Regional Anesthesia and Pain Medicine 2001; 26(4):301-5.
  74. Krusz JC, Scott V, Belanger J. Intravenous propofol: unique effectiveness in treating intractable migraine. Headache: The Journal of Head and Face Pain 2000; 40(3):224-30.
  75. Massou S, Drissi M, Hatim G, Ibat D, Kamili ND, Atmani M. Does propofol have effect on postdural puncture headache?. InAnnales francaises d'anesthesie et de reanimation 2008; 27(10): 861-2.
  76. Mohamed AG, Refky MA, Sayouh EF, Abdelnaby SM. The Effect of Intravenous Infusion of Propofol or Aminophylline on Incidence and Severity of Post-dural Puncture Headache in Elective Cesarean Section. The Egyptian Journal of Hospital Medicine 2021; 84(1):2646-54.
  77. Mokri B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia—evolution of a concept. InMayo Clinic Proceedings 1999; 74(11):1113-23. Elsevier.
  78. Miyazawa K, Shiga Y, Hasegawa T, Endoh M, Okita N, Higano S, et al. CSF hypovolemia vs intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology 2003; 60(6):941-7.
  79. Gentile S, Giudice RL, Martino PD, Rainero I, Pinessi L. Headache attributed to spontaneous low CSF pressure: report of three cases responsive to corticosteroids. European journal of neurology 2004; 11(12):849-51.
  80. Neves JF, Vieira VL, Saldanha RM, Vieira FD, Coutinho Neto M, Magalhães MG, et al. Uso da hidrocortisona no tratamento e na prevenção da cefaléia pós-punção da dura-máter: relato de casos. Rev Bras Anestesiol 2005; 55:343-9.
  81. Alam MR, Rahman MA, Ershad R. Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache. J Anaesthesiol Clin Pharmacol 2012; 28(2):190-3.
  82. Vatankhah M, Sadeghi SE, Zarenezhad M, Rasekh Jahromi A, Kalani N, Hatami N, et al. Low doses of propofol and midazolam on maternal hemodynamic symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section: A double-blind randomized clinical trial study. Iran J Obstet Gynecol Infertil 2021; 24(2):41-9.
  83. Jarineshin H, Sadeghi SE, Malekshoar M, Sanie Jahromi MS, Rahmanian F, Hatami N, et al. Non-pharmacological methods of controlling nausea and vomiting during pregnancy in Iran: A narrative review study. Iran J Obstet Gynecol Infertil 2022; 24(12):110-23.
  84. Ghasemloo H, Sadeghi SE, Jarineshin H, Rastgarian A, Taheri L, Rasekh Jahromi A, et al. Control of nausea and vomiting in women undergoing cesarean section with spinal anesthesia: A narrative review study on the role of drugs. Iran J Obstet Gynecol Infertil 2021; 24(7):98-107.
  85. Malekshoar M, Vatankhah M, Rasekh Jahromi A, Ghasemloo H, Mogharab F, Ghaedi M, et al. Shivering control in women under spinal anesthesia: A narrative review on the role of drugs. The Iran J Obstet Gynecol Infertil 2021; 24(7):61-9.
  86. Zabetian H, Rahmanian M, Tadayon N, Kalani N. Comparison of pain with bupivacaine and bupivacaine-sufentanil combination in women undergoing cesarean section with spinal anesthesia: A double-blind randomized clinical trial. Iran J Obstet Gynecol Infertil 2022; 25(8):8-18.
  87. Zabetian H, Rahmanian M, Damshenas M, Rastgarian A, Nabipour M, Hatami N, et al. The effect of adding pethidine to bupivacaine 0.5% and ropivacaine 0.5% on pain intensity in women undergoing elective cesarean section with spinal anesthesia: A double-blind randomized clinical trial study. Iran J Obstet Gynecol Infertil 2022; 25(2):1-12.