Management of Post-Dural Puncture Headache in Postpartum Women: A Clinical and Therapeutic Update.

Post-dural puncture headache (PDPH) is a common complication of neuraxial anesthesia, particularly in the obstetric population, where its incidence is higher due to the frequent use of epidural techniques and the occurrence of accidental dural puncture. The condition arises from cerebrospinal fluid leakage following disruption of the dura mater, leading to intracranial hypotension, compensatory cerebral vasodilation, and traction of pain-sensitive structures, which collectively explain its characteristic orthostatic presentation. Pregnancy-related physiological changes, including increased intra-abdominal pressure and epidural venous engorgement, further contribute to its development and severity. Clinically, PDPH presents as a positional headache that worsens in the upright position and improves with recumbency, often accompanied by nausea, photophobia, diplopia, and auditory symptoms. Diagnosis is primarily clinical and relies on a history of recent neuraxial procedures and the absence of red flag neurological signs. However, careful evaluation is necessary to exclude other serious postpartum conditions such as preeclampsia, cerebral venous sinus thrombosis, and intracranial hemorrhage. Prevention focuses on optimizing procedural techniques, including the use of small-gauge atraumatic needles, minimizing puncture attempts, and ensuring proper training. Management strategies depend on symptom severity and range from conservative measures, such as hydration, analgesics, and caffeine, to pharmacological interventions. In moderate-to-severe cases, the epidural blood patch remains the gold standard treatment, offering high success rates. Given its potential impact on maternal function, breastfeeding, and mental health, a multidisciplinary and patient-centered approach is essential to improve outcomes and reduce long-term complications.