A recent study indicated that interventions targeting the greater occipital nerves appear to have a significant role in the management of persistent headache after accidental dural puncture (PHADP).  This 9-year prospective audit study was carried out to explore the safety and efficacy of a new management pathway in  PHADP-affected obstetrics presenting to a pain medicine clinic. 

PHADP-affected obstetric patients who had been referred to a pain medicine specialist were prospectively followed up. Accidental dural puncture (ADP) reports from 2008 to 2019 were available. Pharmacological treatments and brain imaging were part of the initial care. Greater occipital nerve (GON) block with depot methylprednisolone and pulsed radiofrequency treatment were options for patients who did not show adequate response.  A headache diary was finished for four weeks before initiating therapy. It was maintained for twenty-four weeks following an intervention.

Data was gathered on the utilization of epidural blood patches to relieve postdural puncture headaches, previous headache histories, headache severity, how long persistent headaches lasted, job status, and low back discomfort. In the clinic, 54 obstetric patients with PHADP treated with a 16-gauge Tuohy needle during a 9-year period were reviewed. Forty individuals (40/54, or 74%) reported having a chronic daily headache. In 50 patients (50/54, 93%), brain imaging did not show any evidence of intracranial hypotension. There was a 5.7-year mean follow-up period.

Two patients (2/54, 4%) were lost to follow-up. A total of 17 patients (17/52, 33%) responded well to pharmacological treatment. Notably, 35 patients (35/52, 67%) who received medical care but had no improvement in their symptoms were provided GON block. Notably, 14 out of 35 subjects (about 40%) declined the intervention. A total of 21 patients underwent nerve blocks, and 18 of them (18/21, 86%) reported a persistent effect that lasted for 24 weeks. The three patients (100%) who had pulsed radiofrequency treatment for GONs illustrated long-lasting improvements.

In the group of patients who were given GON treatment, the mean monthly headache frequency was 4.1, compared to 8.6 in the group who declined nerve blocks, and 5.9 in the group who underwent medical management. ADP can cause headaches to last for more than three years. PHADP management seems to involve interventions aimed at the GONs.