A new guideline from the Obstetric Anaesthetists Association underlines how little evidence is really available to guide management of post dural puncture headache. Epidural Blood Patch remains the best treatment but in general is more effective after 48 hours. Some relief occurs in up to 80%, and complete resolution of pain in about a third. It may need repeating. 20mL blood is suggested or less if back pain develops.
There is insufficient evidence on a whole host of suggested treatments – steroids, gabapentinoids, ACTH, caffeine, triptans, theophylline, neostigmine and atropine, acupuncture, various nerve blocks, and epidural crystalloid.