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All Journal Journal of Anaesthesia and Pain
Mangkuwerdojo, Liliana
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Health Professions Medicine & Pharmacology

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Persistent Post-Dural Puncture Headache in an Autoimmune Patient: Diagnostic Challenges and Successful Management with Epidural Blood Patch Mangkuwerdojo, Liliana; Pryambodho; Sukmono, Raden Besthadi
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Epidural blood patch (EBP) remains the gold-standard intervention for post-dural puncture headache (PDPH), offering rapid and substantial symptom relief. Case: A female in her 20s underwent diagnostic lumbar puncture for evaluation of suspected autoimmune disease. Approximately three days following the procedure, she developed a progressively worsening orthostatic headache (Visual Analogue Scale [VAS] 3–4 at baseline, escalating to 8–9 with positional changes), accompanied by photophobia, nausea, and pain with eye movement. Conservative management and transnasal sphenopalatine ganglion (SPG) block provided only partial and transient relief. An EBP was subsequently performed using 10 mL of autologous blood, resulting in complete bilateral resolution of headache at 24-hour follow-up without significant adverse effects. Conclusion: This case highlights the effectiveness of EBP in managing refractory PDPH unresponsive to conservative treatments and SPG block, even in patients with complex autoimmune backgrounds. EBP remains the definitive treatment for refractory PDPH as a safe and effective option, including in selected patients with underlying autoimmune disease.
Co-Authors Pryambodho Sukmono, Raden Besthadi