Recurrent postdural puncture headache.

Abstract

A14-year-old female presented with a 3-day history of generalized headache, photophobia, neck stiffness and nausea. She had no history of neurological illness or trauma. Clinical examination was normal. Complete blood count, serum urea and creatinine, urine culture and throat swab culture were normal. Dural puncture was carried out under aseptic technique. A 22-gauge Sprotte spinal needle was inserted between the third and fourth lumbar vertebrae, and thirty drops of clear cerebrospinal fluid were removed. Laboratory examination of the fluid was normal, and the patient was treated with analgesics. The headache improved, but did not resolve completely. She was discharged the following day, but presented 4 weeks later, with a severe, intermittent frontotemporal headache. It was associated with nausea, aggravated by changing posture, and transiently relieved by abdominal pressure. Postdural puncture headache was diagnosed, and a blood patch relieved her symptoms completely. Four weeks later, she presented with a recurrence of headache. A second blood patch relieved her symptoms again. Four weeks later, she presented again with a recurrence of headache. Computed tomography of brain and magnetic resonance imaging of lumbar spine were normal. She was treated with amitriptyline and carbamazepine. Symptoms improved, and her pain-free intervals became longer. Three months after the dural puncture she still had headache.