Management of postdural puncture headache: greater occipital nerve block technique

Background Although epidural blood patch remains the gold standard for the treatment of postdural puncture headache (PDPH), it may not be successful in severe and persistent cases. Greater occipital nerve block (GONB) is a novel and easy technique that can be performed in an anesthesia clinic. The present study was carried out to evaluate ultrasound-guided GONB as a line of management for patients with PDPH. Materials and Methods We examined 30 patients age range 18–60 years, of both sexes American Society of Anesthesiologists I–II who developed PDPH either after a cesarian section or any operation under spinal anesthesia. Patients were randomized into two groups: the GONB group, which received ultrasound-guided GONB, and the control group, which received medications. Patients were examined for development of PDPH either during hospitalization or within 2 weeks of operation. If headache was not relieved within both groups, epidural blood patch was performed 24–48 h from the start of medical treatment in the control group but from the time of GONB in the study group. We recorded time of improvement or disappearance of headache, amount of analgesic consumption, and any side effects. Results Patients in the GONB group showed a statistically significant lower numerical rating score and greater improvement than the control group (P 0.0001) during the second 12 h. The headache was completely relieved in the GONB group within a significantly shorter time than in the control group: 29.20 ± 14.67 and 73.60 ± 43.47 h, respectively (P = 0.00). Tramadol and pregabalin were consumed significantly less by the participants in the GONB group compared with those in the control group (P 0.001). Conclusion GONB is a potentially useful alternative technique for the management of PDPH.