Background and Aims Post-puncture headache – an unpleasant rare event. Associated with epidural and spinal anesthesia. With epidural anesthesia, its cause is an unintentional puncture of the inner leaf of the dura mater. With spinal, intrathecal puncture itself.

Methods 20 years of experience in post-puncture headache in a maternity hospital (~ 200 observations), associated with epidural analgesia in childbirth.

Results Almost 100% of observations – unintentional puncture of the inner leaf of the dura mater with an epidural needle. Manifests 6–18 hours after removal of the epidural catheter. In less than 50% of cases amenable to conservative treatment. Classical triad (bedrest, hydration, tylenol) – temporary unstable relief. Most have an epidural blood patch. In case of refusal, contraindications for filling, strict adherence to bed rest for 10–14 days. A single epidural blood patch with autoblood with a volume of 10–20 ml in almost 100% permanently relieves a headache. Repeated epidural autologous blood filling is required only in 1–2% of cases. In 1–2% of our cases of epidural blood patch, we observed short-term, up to 3–5 days, development of meningeal symptoms, in particular, pronounced occipital rigidity against the background of complete disappearance of positional headache. This occipital stiffness looks quite frightening, but usually practically does not bother patients and regresses spontaneously by 5 days after a blood patch.

Conclusions A possible explanation for the development of meningeal symptoms immediately after an epidural patch is the ingestion of a small amount of autologous blood into the subarachnoid space, followed by irritation of the dura mater.