Greater occipital nerve block for postdural puncture headache (PDPH): A prospective audit of a modified guideline for the management of PDPH and review of the literature

Study Objective: To perform a prospective audit of the modified guideline for the management postdural puncture headache (PDPH) and present the results at 6 months. Design: Prospective single-center audit. Setting: University hospital. Patients: 24 adult, ASA physical status 1, 2, and 3 patients presenting with PDPH in both the obstetric and nonobstetric setting. Interventions: Epidural blood patch (EBP) and bilateral greater occipital nerve blocks (GONB) were administered. Measurements: Headache scores, nausea scores, presence and severity of neck stiffness, tinnitus, photophobia, and any complications with either technique. Results: 24 patients were audited. Nineteen patients failed conservative management and were offered both GONB and EBP. One patient chose the EBP and was successfully treated. Of the 18 patients who received the GONB, headache resolved in 12 patients (66%). Six patients had a partial response to nerve block and were treated with an EBP. Conclusion: Greater occipital nerve block with dexamethasone may have a role in the management of patients presenting with PDPH, who have failed conservative management. We present the results of our prospective audit and review the literature on GONB in the management of PDPH. (C) 2014 Elsevier Inc. All rights reserved.