The risk of a headache after accidental dural puncture (i.e., with an epidural needle) is approximately 50%. However, keep in mind that headaches occur in 12% of all parturients who have an epidural (and 15% of parturients who don’t have an epidural).
For patients whose dura is violated intentionally (ex. spinal anesthetic, CSE, DPE), the most important modifiable risk factors have to do with needle selection – small (24 or 25 ga.) pencil point (Whitacre or Sprotte) needles should be selected. A large (22 ga.) Quincke needle can produce PDPH in 30-70% of cases, whereas a small (24-25 ga.) Whitacre or Sprotte needle will produce PDPH in only 3-5%.
Risk Factors for Post-Dural Puncture Headache
- Beveled (Quincke) needle (pencil-point needles are preferable)
- Larger needle
- Female gender
- Younger age
- History of headache prior to the dural puncture
- K M Kuntz, E Kokmen, J C Stevens, P Miller, K P Offord, M M Ho Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology: 1992, 42(10);1884-7
- Christopher L Wu, Andrew J Rowlingson, Seth R Cohen, Robert K Michaels, Genevieve E Courpas, Emily M Joe, Spencer S Liu Gender and post-dural puncture headache. Anesthesiology: 2006, 105(3);613-8