///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00


Abstract Number: 80
Abstract Type: Case Report/Case Series

Krzysztof M. Kuczkowski M.D.1


K.M. Kuczkowski, M.D.,

Texas Tech University Health Sciences Center, El Paso, TX, USA

Introduction: Caffeine is probably the most frequently ingested pharmacologically active substance in the world. Reproductive-aged and pregnant women are 'at risk' subgroups of the population who may require specific advice on moderating their daily caffeine intake. Clinical research indicates that withdrawal symptoms can occur when daily consumption of caffeine is abruptly interrupted (e.g., in labor). The caffeine physical dependence syndrome may lead to peripartum complications such as nausea, vomiting, muscular aches and headache (1). In parturients receiving epidural analgesia for labor caffeine withdrawal headache may be mistaken for post-dural puncture headache (PDPH).

Report of case: Indeed, in his practice of obstetric anesthesia the author of this report encountered a 29-year-old otherwise healthy female at 39 weeks gestation who was in labor and consented to epidural analgesia, which was performed (uneventfully) in a standard manner with an 18-GA Tuohy-Schliff epidural needle. Postpartum the patient developed severe headache initially thought to resemble PDPH, however, upon detailed questioning the patient admitted to a heavy caffeine intake throughout pregnancy. The diagnosis of caffeine withdrawal headache was established. The headache was treated (successfully) with a cup of coffee.

Discussion: Epidural analgesia is widely considered as the most effective method of providing pain relief during labor. Pregnant women are at particular risk of dural puncture, and the subsequent PDPH, because of sex, young age, and the widespread application of regional anesthesia. The differential diagnosis of PDPH is often clear from the history of dural puncture and the presence of a severe postural headache. However, it is important to consider alternative causes of headache including withdrawal of caffeine. Most Americans consume caffeine daily in one of its many forms (1). A cup of coffee, for example, contains 29 to 176 mg of caffeine depending on its strength. It has been reported that approximately 80% of women drink caffeine-containing beverages daily. Caffeine is readily absorbed from the mucosa of the gastrointestinal tract. It crosses the human placenta rapidly reaching concentration in the fetus similar to maternal plasma levels. Caffeine has been implicated as a cause of spontaneous abortion, intrauterine growth restriction, low birth weight and preterm delivery.

Conclusion: Maternal use of caffeine in pregnancy continues to increase - worldwide. It is suggested that reproductive-aged women should consume

Questioning regarding caffeine intake should be considered in all patients presenting with postpartum headeaches.

References: Curr Opin Obstet Gynecol 2007; 19:578-585.

SOAP 2009