Lumbar puncture is an invasive procedure by which medical personnel try to get a sample of cerebrospinal fluid though a needle inserted into the lower lumbar area for diagnostic purposes (i.e. meningitis or subarachnoid haemorrhage). It is also used to inject medications such as anaesthetics and analgesics to perform a regional anaesthesia or chemotherapy. Post-dural puncture headache (PDPH) is the most common complication of a lumbar puncture. The symptoms are a constant headache that worsens in the upright position and improves when lying down and resolves spontaneously within five to seven days. Numerous medications are used in clinical practice to treat PDPH, so the aim of this review was to assess the effectiveness of these drugs.
We included seven randomised clinical trials (RCTs), with a total of 200 participants, that assessed six medications (caffeine, sumatriptan, gabapentin, hydrocortisone, theophylline and adrenocorticotropic hormone). Caffeine proved to be effective in decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions. Gabapentin, theophylline and hydrocortisone also proved to be effective, decreasing pain severity scores better than placebo or conventional treatment alone, respectively. A meta-analysis (combining of data) was not possible because all the included RCTs assessed different drugs or different outcomes. Lack of information to allow correct appraisal of the risk of bias and the small sample sizes (number of patients) of the RCTs may limit the conclusions of this review.