What works for the management of PDPH; is the current evidence enough?

ABSTRACT

Post Dural Puncture Headache [PDPH] is apparently not an uncommon occurrence and in most cases need serious attention. Conservative, supportive non-pharmacological management to interventional invasive and pharmacological treatment of PDPH are reported in the literature. The PDPH treatment strategies can be divided into symptom management and mechanism directed therapies, both of which complement each other. Supportive management for symptom relief includes soft pain killers, non-steroidal anti-inflammatory drugs, oral hydration and caffeinated drinks. If PDPH does not resolve then epidural blood patch is considered a definitive intervention. Novel pharmacological therapies tested and reported include use of triptans. Over two decades, sumatriptan has been used in a staggered manner and some reports of its success and lack of effectiveness appeared in the literature. In this issue Riaz A. et al have reported the first successful use of Zolmitriptan for PDPH. Although recent Cochrane review is not supportive of triptan use in PDPH but the review could not include Zolmitriptan therapy in PDPH since the original research article in this issue is the first reported use of it. This editorial view discusses the PDPH prevention, current therapeutic strategies, and novel pharmacological management with triptans. Future research and reporting is encouraged for PDPH management and the clinicians might welcome 'whatever works strategy', if supported by clinical reasoning, scientific evidence and in practice safely without causing any harm