Q: Name few treatments for Post-lumbar puncture headache (PHPHA) if bed-rest and conventional analgesics don't work?


Answer: 

• Epidural blood patch 1
• Caffeine (oral or IV) 2,3
• IM adrenocorticotropic hormone (ACTH) 4
• IV hydrocortisone 5
• PO  theophylline 6
• SQ sumatriptan 7
• sphenopalatine block 8
• PO gabapentin 9
• Epidural saline 10

References:

1. Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev 2010; :CD001791. 

2.  Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg 1990; 70:181. 

3. Jarvis AP, Greenawalt JW, Fagraeus L. Intravenous caffeine for postdural puncture headache. Anesth Analg 1986; 65:316. 

4. Foster P. ACTH treatment for post-lumbar puncture headache. Br J Anaesth 1994; 73:429

5. Noyan Ashraf MA, Sadeghi A, Azarbakht Z, et al. Evaluation of intravenous hydrocortisone in reducing headache after spinal anesthesia: a double blind controlled clinical study [corrected]. Middle East J Anaesthesiol 2007; 19:415.

6. Feuerstein TJ, Zeides A. Theophylline relieves headache following lumbar puncture. Placebo-controlled, double-blind pilot study. Klin Wochenschr 1986; 64:216

7. Connelly NR, Parker RK, Rahimi A, Gibson CS. Sumatriptan in patients with postdural puncture headache. Headache 2000; 40:316. 

8. Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med 2015; 33:1714.e1.

9. The effect of oral gabapentin on postdural puncture headache. Acute Pain 2006; 8:169.

10. RICE GG, DABBS CH. The use of peridural and subarachnoid injections of saline solution in the treatment of severe postspinal headache. Anesthesiology 1950; 11:17.