Post Spinal Headache: Special Considerations in Obstetric Patients

Spinal anesthesia is the most commonly used regional block in anesthetic practice. Central neural block (CNB) is administered frequently for caesarean section. Post-spinal headache (PSH) is the most frequent and discomforting late complication of spinal anaesthesia. PSH is an important cause of iatrogenic maternal co-morbidity and maternal dissatisfaction. The exact mechanism of headache following PSH is not clear. Different associated symptoms may be there with PSH which may mimic other clinical conditions presenting as headaches. Expedited discharge of the mother or delayed onset of PSH in some women may not capture all the mothers developing PSH after hospital discharge. The mother having PSH might first report to the obstetrician. A pilot study in our institute, regarding knowledge and practice of treatment of PSH amongst obstetricians demonstrated limited knowledge of PSH. Bedrest, fluids, analgesics, caffeine, Sphenopalatine ganglion block, and Epidural blood patch are treatment modalities commonly used for PSH management.

Even though PSH is a self-limiting condition, a subset of patients will suffer from potentially life-threatening neurological consequences. Such a patient needs urgent referral to an anaesthesiologist, neurologist, and special radiological investigations for definitive diagnosis and treatment. Epidural Blood Patch should be considered to treat PSH which impairs the daily activities of the patient and is refractory to conservative therapy or the patient has other neurological sequelae of PSH like hearing loss and cranial nerve palsy. Awareness needs to be there amongst obstetricians regarding PSH to avoid medicolegal problems and patients also are to be educated about red flag symptoms once they develop PSH.

This article reviews the pathophysiology, clinical picture, and management of PSH with special considerations during the postpartum period.