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Impact of Migraine Headache and Depression/Anxiety on the Incidence of Post-Dural Puncture Headache during Postpartum
Abstract Number: S4B-2
Abstract Type: Original Research
Objective: The aim of this retrospective analysis was to identify and assess the risk of developing a post-dural puncture headache (PDPH) in patients with a documented history of primary migraine and anxiety/depression.
Methods: We conducted a retrospective chart review and analysis of patient case logs from the Department of Obstetric Anesthesiology between January 2011 and June 2015. The data of 175 patients who had accidental dural puncture (ADP) during epidural placement were included and further analyzed for the development of a post-dural puncture headache (PDPH). We compared patient demographics and history of depression/anxiety, as well as evaluated patient history of prior migraine headaches.
Results: A total of 17,497 epidurals were attempted for vaginal deliveries, 175 patients met our criteria for ADP, from which 52.6% developed PDPH. Epidural blood patch treatment was required in 37% of patients with PDPH. A history of migraines was present in 70% of patients with PDPH, from which 57.1% required an epidural blood patch treatment. A history of depression/anxiety was found in 58.3% with PDPH, of which 52.1% required an epidural blood patch. Data analysis showed no significant difference between history of migraine or depression/anxiety and the incidence of dural puncture headache (P=0.26 and P=0.68) respectively, nor association between history of migraine or depression/anxiety and the intensity of dural puncture headache (P= 0.25 and P=0.63), respectively.
Conclusions: The results of this study indicate that in postpartum patients with accidental dural puncture during epidural placement, the presence of a history of migraine or depression/anxiety were neither associated with an increased risk of developing or increased intensity of post-dural puncture headache.
1. Stefka M, Spaska G- Zhostova, Todorov B., et al. The impact of anxiety on post-dural puncture headache in routine neurology practice. International Journal of Surgery and Medicine. 2015; 1(2); 53-57.
2. van Oosterhout WP, van der Plas AA, van Zwet EW, et al. Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study. Neurology. 2013;80(10):941-8.
3. Munts AG, Voormolen JH, Marinus J, et al. Postdural puncture headache in complex regional pain syndrome: a retrospective observational study. Pain Medicine. 2009;10(8): 1469-1475.