Postdural puncture headaches, or spinal headaches, are the most common complication of lower back punctures, lasting from a few hours to a few days. The puncture can occur intentionally - when drawing a sample of cerebrospinal fluid for a diagnosis, for example - or unintentionally with anesthesia or a medication injection at the lower back.
Researchers led by Xavier Basurto Ona of the Hospital de Figueres in Catalonia, Spain, now show that caffeine treatment can decrease the number of patients with persistent puncture headaches, when compared to a placebo. Both oral and intravenous caffeine work, with the IV form especially helpful in lessening the duration of the headaches.
Other medicines, including the prescription painkiller gabapentin, the steroid hydrocortisone and the asthma drug theophylline also can lessen the pain of the headaches compared to placebo.
"Numerous medications are used in clinical practice to treat postdural puncture headache, so the aim of this review was to assess the effectiveness of these drugs," Basurto Ona explained.
The new review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The constant headaches usually start within 15 minutes of the puncture, and grow worse when a person stands or sits up. Researchers are still debating their exact cause, but many believe that the headaches are the result of a small leak of cerebrospinal fluid at the puncture site.
"Approximately 50 percent of patients with the headaches get better within the first four days after the lumbar puncture," said Sait Ashina, M.D., director of the Headache Program at Albert Einstein College of Medicine in New York.
The Cochrane reviewers analyzed seven studies including 200 patients, which compared treatments for the headaches. The patients underwent treatment in the United States, Germany, the United Kingdom, Turkey and Iran, and were mostly women who received regional anesthesia during labor.
Ashina said patients seeking relief have also used alternative therapies such as rest, hydration and abdominal compression binders. "Conservative nondrug therapies for lumbar puncture headaches always need to be considered prior to starting aggressive therapies with drugs," he said.
Since most of the patients in the Cochrane studies were women in labor, the results might not have wide applicability, Basurto Ona cautioned. Larger and more diverse studies could help confirm whether caffeine is a good choice for treating most postdural puncture headaches.
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The Cochrane Library
contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org
for more information.
Basurto Ona X, et al. Drug therapy for treating post-dural puncture headache (Review). Cochrane Database of Systematic Reviews 2011, Issue 8.