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#36212 Post-puncture headache recurrence (pphr) after a blood patch – a clinical case
  1. Sara Fernandes,
  2. Mariana Pascoal,
  3. Margarida Gil,
  4. Piedade Gomes and
  5. Ana Almeida
  1. Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal


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Background and Aims Post-Puncture Headache Recurrence (PPHR) is a complication of performing neuraxial techniques. Performing a blood patch is a recognized treatment with a high success rate, however, recurrence of headaches after it has been described.

Methods Clinical case: 33 years pregnant. Admitted for induction of labor. An epidural block was performed for labor analgesia, which complicated with accidental perforation of the dura mater with a Touhy needle. Six hours after delivery, headache typical of PPHR started, so conservative treatment was instituted. Due to the lack of symptoms improvement, a sphenopalatine block was carried out with no symptomatic improvement. For that reason, a blood patch was decided upon, resulting in complete resolution of the symptoms and the patient was discharged the following day. That night, she returned to the hospital due to a relapse of severe headache. After discussing the case with a Neurology specialist, a Magnetic Resonance Imaging performed that showed no signs of cerebral spine fluid hypotension. Conservative treatment was decided. The patient was discharged 4 days later with partial improvement of her condition.

Results PPHR after performing a blood patch has been described. The risks and benefits of performing a new blood patch or conservative treatment must be weighed. Before starting treatment for PPHR, it is necessary to make a differential diagnosis with other causes of headache in the puerperium after performing neuraxial techniques.

  • Post-Puncture Headache
  • Recurrence
  • Epidural block
  • Pregnancy

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