What works for the management of PDPH; is the current evidence enough?

Abstract

Post Dural Puncture Headache (PDPH) is apparently not an uncommon occurrence and in most cases need serious
attention. Conservative, supportive non-pharmacological management to interventional invasive and pharmacological
treatment of PDPH are reported in the literature. The PDPH treatment strategies can be divided into symptom management
and mechanism directed therapies, both of which complement each other. Supportive management for symptom relief
includes soft pain killers, non-steroidal anti-inflammatory drugs, oral hydration and caffeinated drinks. If PDPH does
not resolve then epidural blood patch is considered a definitive intervention. Novel pharmacological therapies tested
and reported include use of triptans. Over two decades, sumatriptan has been used in a staggered manner and some
reports of its success and lack of effectiveness appeared in the literature. In this issue Riaz A. et al have reported the
first successful use of Zolmitriptan for PDPH. Although recent Cochrane review is not supportive of triptan use in
PDPH but the review could not include Zolmitriptan therapy in PDPH since the original research article in this issue is
the first reported use of it. This editorial view discusses the PDPH prevention, current therapeutic strategies, and novel
pharmacological management with triptans. Future research and reporting is encouraged for PDPH management and
the clinicians might welcome ‘whatever works strategy’, if supported by clinical reasoning, scientific evidence and in practice
safely without causing any harm.