Purpose of review. Postdural puncture headache (PDPH) is a common complication after spinal anaesthesia or inadvertent dural puncture. The most effective treatment option for patients with unsuccessful conservative management is an epidural blood patch (EBP), which is invasive and may result in rare but severe complications. The purpose of this article is to review the efficacy of the most studied alternatives to EBP for treatment of PDPH.Recent findings. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. Although EBP is the most reliable, there are some patients in whom this treatment is refused or contraindicated. Sphenopalatine ganglion block with bilateral transnasal local anaesthetic instillation is suggested as a simple, minimally invasive treatment for PDPH, but the most recent studies showed no statistically significant effect on pain intensity. Much more effective is the semi-forgotten intravenous aquatherapy after Leriche with distilled water (20-40 ml), giving fast effect (in several minutes).Conclusions. In cases of ineffective conservative therapy, we recommend the seriatim treatment, beginning from the least invasive sphenopalatine ganglion block with intranasal local anaesthetic instillation, then intravenous aquatherapy after Leriche, then EBP.