Conservative treatment for post-dural puncture headache in obstetric patients
Keywords:
anesthesia, obstetric; conservative treatment; post-dural puncture headacheAbstract
Introduction: Post-dural puncture headache is a frequent complication following neuroaxial techniques in obstetrics. Its initial management is usually conservative, although the evidence supporting these interventions is heterogeneous.
Objective: To synthesize the available literature on the efficacy and use of conservative treatment for post-dural puncture headache in obstetric patients.
Method: A narrative literature review was conducted in the PubMed, Scopus, Web of Science, SciELO, Cochrane, and ClinicalKey databases. The search included articles published between 2015 and 2025, using the descriptors: obstetric anesthesia, post-dural puncture headache, and conservative treatment. Out of 90 identified articles, 30 that met the inclusion criteria were selected.
Development: The literature reports that prophylactic conservative measures such as prolonged bed rest, forced hydration, or the use of abdominal binders lack solid evidence to support their efficacy. Technique optimization (use of fine-gauge and pencil-point needles) is the most consistently supported preventive strategy. For established headache, simple oral analgesics in multimodal regimens and caffeine are the most frequently described interventions, although the evidence for their effectiveness is variable. Other pharmacological therapies show contradictory results or insufficient evidence.
Conclusions: A variety of conservative options are described for the management of post-dural puncture headache in obstetrics. However, the evidence supporting most of these interventions is of moderate to low quality and very heterogeneous, highlighting the need for more rigorous studies.
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References
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