Post-Dural Puncture Headache — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

EasyRegional AnaesthesiaPost-Dural Puncture HeadacheFRCA Final

A 32-year-old woman develops a severe headache 24 hours after lumbar epidural analgesia for labour. The headache is worse when sitting or standing and is relieved by lying flat. It is associated with neck stiffness and photophobia. She is afebrile, her blood pressure is normal and neurological examination is normal. The symptoms remain disabling despite conservative treatment for 48 hours. What is the most appropriate definitive treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Epidural blood patch

The correct answer is C, an epidural blood patch. The delayed onset, marked postural component, neck stiffness and photophobia following neuraxial analgesia are characteristic of post-dural puncture headache caused by persistent cerebrospinal fluid leakage and reduced intracranial pressure. After disabling symptoms have persisted despite conservative treatment, autologous blood injected into the epidural space is the treatment of choice. It increases epidural pressure initially and subsequently seals the dural defect. Caffeine may provide temporary symptomatic benefit but is not definitive treatment. Sumatriptan treats migraine, while dexamethasone is not an established treatment for post-dural puncture headache. Intrathecal saline is not recommended as routine definitive therapy. Persistent, atypical or non-postural symptoms would require reassessment for alternative postpartum causes.

Reference: Royal College of Anaesthetists and Obstetric Anaesthetists' Association. Headache after a spinal or epidural anaesthetic, second edition, May 2025. https://rcoa.ac.uk/sites/default/files/documents/2025-11/Risk-HeadacheSpEp2025.pdf