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Intensity of post-dural puncture headaches and sphenopalatine ganglion blocks
Abstract Number: SUN-50
Abstract Type: Case Report/Case Series
Post-dural puncture headache (PDPH) is a common complication associated with neuraxial anesthesia, particularly in the obstetric population (1). Sphenopalatine ganglion blocks (SPGB) have been used effectively to treat cluster headaches, migraines, and post-dural puncture headaches (2,3,4,5). We present two case reports using SPGB for PDPH.
The first patient was a 27-year-old female who presented in labor at 32 weeks gestation. After multiple epidural attempts, she had an inadvertent dural puncture, and a catheter was threaded intrathecally. At catheter removal, CSF was noted to be leaking from the catheter cap. Patient complained of a bifrontal positional headache, dizziness, and nausea with ambulation. Her pain was 10/10, and she was reportedly unable to move from the supine position. A blood patch was attempted that resulted in a second dural puncture. Prior to receiving a fluoroscopic guided blood patch, the patient elected to try a SPGB. The patient was placed in supine position and received bilateral transnasal SPGB with 2% viscous lidocaine applied with cotton tip applicators. Immediately after the block, the patient reported a decrease in her pain to 4/10 as well as alleviation of her other symptoms, even with elevation of the head of the bed. Upon follow up, patient reported her pain and symptoms returned 2 hours after block application.
The second patient was 26-year-old female at 37 weeks who received spinal anesthesia for primary cesarean section. Two attempts for spinal were performed as the first spinal revealed a patchy block. Patient complained of a frontal-occipital headache worsening with postural changes, and she wanted to pursue options other than a blood patch to alleviate headache. Transnasal SPGB was performed in the same manner as noted in the first case. Her pain score prior to SPGB was 4/10. Patient reported immediate relief with pain score 0/10. On follow up 48 hours later, patient reported continued relief of headache following the block.
SPGB is potentially an effective therapy for PDPH that can be offered to patients prior to receiving a blood patch. The duration and degree of symptom relief experienced with the SPGB could be attributed to the intensity of the headache. SPGB could be used as a bridge until a blood patch can be placed in a patient demonstrating severe symptoms. In some cases, the block could replace the need for blood patch, as demonstrated by our second case. Further studies are needed to elucidate the relationship between PDPH severity and SPGB.
1. Semin Perinatol 2014; 38 386-394 2. Headache 2016; 56: 240-258 3. Reg Anesth Pain Med 2014; 39:563 4. Anaesthesia 2009; 64:574–575 5. J Clin Anes 2016; 34: 194-196