Treating Post-Dural Puncture Headaches: Sphenopalatine Block, Cosyntropin And Epidural Blood Patch

Post-dural puncture headache (PDPH) is a severe and debilitating complication that can occur following neuraxial anesthesia. Obstetric patients are at an increased risk for this complication due to their gender, young age, and widespread use of neuraxial anesthesia. A hallmark sign of PDPH is a postural headache that improves when lying down and worsens when sitting or standing. It requires prompt diagnosis and treatment due to its incapacitating effects. The gold-standard treatment for PDPH is an epidural blood patch (EBP). However, this is an invasive procedure with multiple contraindications and the potential for severe complications. Noninvasive, more conservative therapies such as sphenopalatine ganglion block (SPGB) and intravenous (IV) cosyntropin have shown to provide significant relief with PDPH and its associated symptoms. This paper will review the current literature on the management and treatment of PDPH with EBP, SPGB, and IV cosyntropin therapies