Abstract：
OBJECTIVE: This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH).
RESULTS: PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
RESULTS: PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
摘要：
目的：本手稿旨在回顾硬膜穿刺后头痛（PDPH）的风险和当前的治疗方法。
结果：PDPH是神经轴阻滞后相对常见的并发症。它在本质上通常是立位的，表现为位置性和迟钝的疼痛或抽动性头痛，增加了听觉和/或视觉信号的失调。某些特征,比如女性和年轻的年龄，可能使患者容易发展为PDPH，如以前的PDPH等因素，在分娩的第二阶段，和神经轴技术本身。长期并发症，包括硬脑膜穿刺后数年的慢性头痛，已引起人们对PDPH作为自限性头痛的历史分类的质疑。到目前为止,治理PDPH的潜在机制仍在调查中，虽然已经探索了各种各样的预防和治疗措施，并取得了不同程度的成功。在轻度PDPH的情况下，应将包括卧床休息和药物管理的保守管理作为一线治疗。对于保守治疗反应不佳的PDPH患者，神经阻滞是非常有效的选择。在中度至重度PDPH的情况下，硬膜外血贴片仍然是首选的治疗方法。建议采用跨学科的方法来治疗PDPH患者，以达到最佳效果。
结果：PDPH是神经轴阻滞后相对常见的并发症。它在本质上通常是立位的，表现为位置性和迟钝的疼痛或抽动性头痛，增加了听觉和/或视觉信号的失调。某些特征,比如女性和年轻的年龄，可能使患者容易发展为PDPH，如以前的PDPH等因素，在分娩的第二阶段，和神经轴技术本身。长期并发症，包括硬脑膜穿刺后数年的慢性头痛，已引起人们对PDPH作为自限性头痛的历史分类的质疑。到目前为止,治理PDPH的潜在机制仍在调查中，虽然已经探索了各种各样的预防和治疗措施，并取得了不同程度的成功。在轻度PDPH的情况下，应将包括卧床休息和药物管理的保守管理作为一线治疗。对于保守治疗反应不佳的PDPH患者，神经阻滞是非常有效的选择。在中度至重度PDPH的情况下，硬膜外血贴片仍然是首选的治疗方法。建议采用跨学科的方法来治疗PDPH患者，以达到最佳效果。
