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Post-dural puncture headache — FRCA Final MCQ

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ModerateObstetric AnaesthesiaPost-dural puncture headacheFRCA Final

A 30-year-old woman develops a severe postural headache 36 hours after recognised accidental dural puncture during labour epidural insertion. She is unable to sit to feed her baby despite regular paracetamol, ibuprofen and hydration. Neurological examination is normal and there is no fever. What is the most appropriate pain management?

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Correct answer: E — Offer an epidural blood patch after senior obstetric anaesthetic review

The timing, postural nature and known dural puncture are typical of obstetric post-dural puncture headache. If symptoms impair caring for the baby despite conservative treatment, epidural blood patch is the definitive intervention after review and consent. Routine triptans or prolonged bed rest are not supported as definitive treatment. Atypical features, focal signs or fever would prompt investigation for other intracranial or infective causes.

Reference: OAA guideline on obstetric post-dural puncture headache 2018