Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). The headache is severe and described as "searing and spreading like hot metal", involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement and sitting or standing and is relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are also common.PDPH is a common side effect of lumbar puncture and spinal anesthesia. Leakage of cerebrospinal fluid causes reduced fluid levels in the brain and spinal cord. Onset occurs within two days in 66% of cases and three days in 90%. It occurs so rarely immediately after puncture that other possible causes should be investigated when it does.Using a pencil point needle rather than a cutting spinal needle decreases the risk. The size of the pencil point needle does not appear to make a difference. PDPH is estimated to occur in between 0.1% and 36% people following dural puncture. Signs and symptoms
PDPH typically occurs hours to days after puncture and presents with symptoms such as headache (which is mostly bi-frontal or occipital) and nausea that typically worsen when the patient assumes an upright posture. The headache usually occurs 24–48 hours after puncture but may occur as many as 12 days after.
A 2006 review reported an incidence of:

12% if a needle between 0.4128 mm (0.01625 in) and 0.5652 mm (0.02225 in) is used;
40% if a needle between 0.7176 mm (0.02825 in) and 0.9081 mm (0.03575 in) is used; and
70% if a needle between 1.067 mm (0.0420 in) and 1.651 mm (0.0650 in) is used.On the Birmingham gauge, these correspond to the values 27–24G, 22–20G and 19–16G.PDPH is roughly twice as common in lumbar puncture than spinal anaesthesia, almost certainly due to the atraumatic needles used in spinal anaesthesia. References


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