Postdural Puncture Headache in Complex Regional Pain Syndrome: A Retrospective Observational Study

Pain Medicine

Early View (Articles online in advance of print)

Published Online: 26 Oct 2009

© 2009 American Academy of Pain Medicine

Alexander G. Munts, MD,* Joan H. C. Voormolen, MD, ^† Johan Marinus, PhD,* Elmar M. Delhaas, MD,* and Jacobus J. van Hilten, MD, PhD*

Departments of *Neurology and ^† Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to Jacobus J. van Hilten, MD, PhD, Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: 31-71-5262134; Fax: 31-71-5248253; E-mail: j.j.van_hilten@lumc.nl.

ABSTRACT

Objective. To describe the unusual course of postdural puncture headache (PDPH) after pump implantation for intrathecal baclofen (ITB) administration in patients with complex regional pain syndrome (CRPS)-related dystonia.

Design. Case series based on data collected from 1996 to 2005.

Setting. Movement disorders clinic, university hospital.

Patients. A total of 54 patients with CRPS-related dystonia who were treated with ITB.

Results. A high incidence (76%) and prolonged course (median 18 days, range 2 days to 36 months) of PDPH was found. Radionuclide studies performed in two patients with long-lasting symptoms (12–16 months) did not reveal cerebrospinal fluid (CSF) leakage. In patients without signs of CSF leakage (N = 38), epidural blood patches administered in 24 patients were effective in 54%, while ketamine infusions administered in six patients were effective in 67%.

Conclusions. Our observations may suggest that other mechanisms besides intracranial hypotension play a role in the initiation and maintenance of PDPH in CRPS and stimulate new directions of research on this topic.