A post-dural puncture headache (PDPH) is a type of headache that occurs after a puncture in the dura mater, the tough membrane surrounding the spinal cord and cerebrospinal fluid (CSF). This condition is most commonly seen after procedures such as lumbar punctures or spinal anesthesia. The hallmark of PDPH is that the headache typically worsens when the person is sitting or standing and improves when lying down. This positional nature is due to changes in CSF pressure caused by the leak at the puncture site. The pain is usually located in the front or back of the head and may be accompanied by neck stiffness, nausea, dizziness, or sensitivity to light and sound.
The headache typically begins within 48 to 72 hours after the dural puncture, although it can sometimes be delayed. It results from the loss of CSF, which lowers intracranial pressure and can cause the brain to sag slightly within the skull, stretching pain-sensitive structures. Symptoms can vary in intensity and duration, with some people experiencing mild discomfort while others report severe, debilitating pain. In some cases, additional symptoms such as hearing changes or visual disturbances may occur, reflecting the involvement of cranial nerves due to altered CSF dynamics.
