Post-dural puncture headache after unrecognised dural puncture

Abstract

We report a case of post-dural puncture headache (PDPH) following epidural labour analgesia without an obvious dural puncture. A twenty-eight year primigravida, with a past history of migraine, developed a headache characteristic of PDPH eighteen hours postpartum, even though thorough testing of epidural catheter placement at the time of insertion had been uneventful. She was managed conservatively and her symptoms subsided after one week. A diagnosis of PDPH should be considered in patients who have received epidural analgesia, even in the absence of obvious dural puncture, so that the full range of treatments for this incapacitating condition can be offered.