It usually resolves within a few days but has been rarely documented to take much longer. Pathophysiology
PDPH is thought to result from a loss of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms. Diagnosis
Differential diagnosis
Although in very rare cases the headache may present immediately after a puncture, this is almost always due to another cause such as increased intracranial pressure and requires immediate attention. Prevention
Using a pencil point rather than a cutting spinal needle decreases the risk. The size of the pencil point needle does not appear to make a difference, while smaller cutting needles have a low risk compared to larger ones. Modern, atraumatic needles such as the Sprotte or Whitacre spinal needle leave a smaller perforation and reduce the risk for PDPH. However, the evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache is moderate-quality and further research should be done.Morphine, cosyntropin, and aminophylline appear effective in reducing post dural puncture headaches. Evidence does not support the use of bed rest or intravenous fluids to prevent PDPH. Treatment
Some people require no other treatment than pain medications and bed rest. A 2015 review found tentative evidence to support the use of caffeine. Vigorous hydration is routinely encouraged in postpartum patients as a noninvasive, low-risk therapy.Pharmacological treatments as; gabapentin, pregabalin,  neostigmine/atropine,  methylxanthines, and triptans.
Minimally invasive procedures as; bilateral greater occipital nerve block  or sphenopalatine ganglion block. Persistent and severe PDPH may require an epidural blood patch. A small amount of the persons blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then "patches" the meningeal leak. EBP is effective, and further intervention is rarely necessary. 25-35% of patients suffer from transient back pain after EBP. More rare complications of EBP include misplacement of blood leading to spinal subdural hematoma or intrathecal injection and arachnoiditis, infection with subdural abscess, facial nerve paralysis, spastic paraparesis and cauda equina syndrome. Epidemiology
Estimates for the overall incidence of PDPH vary between 0.1% and 36%. It is more common in younger patients (especially in the 18–30 age group), females (especially those who are pregnant), and those with a low body mass index (BMI). The low prevalence in elderly patients may be due to a less stretchable dura mater. It is also more common with the use of larger diameter needles.