Unintentional dural puncture with a Tuohy needle increases risk of chronic headache

Anesth Analg. 2012 Jul;115(1):124-32. doi: 10.1213/ANE.0b013e3182501c06. Epub 2012 Mar 30.


Background: Neuraxial analgesia is chosen by almost half of women who give birth in the United States. Unintentional dural puncture is the most common complication of this pain management technique, occurring in 0.4% to 6% of parturients. Severe positional headaches develop acutely in 70% to 80% of these parturients. Acute postdural puncture headaches are well known, but few studies have investigated long-term sequelae. We investigated the incidence of and risk factors for chronic headache and chronic back pain in parturients who experienced unintentional dural puncture with a 17-gauge Tuohy needle compared with matched controls.

Methods: In a case control design, 40 parturients who sustained unintentional dural puncture with a 17-gauge Tuohy needle over an 18-month period and 40 controls matched for age, weight, and time of delivery were recruited by telephone and 2 validated questionnaires were administered assessing headache and back pain symptoms 12 to 24 months after delivery.

Results: The incidence of chronic headaches in the study group (28%) was significantly higher than in the matched controls (5%) (OR = 7, P = 0.0129). Subjects who experienced dural punctures were more likely than controls to report chronic back pain (OR = 4, P = 0.0250), but treatment with an epidural blood patch was not a risk factor for chronic back pain.

Conclusions: Patients who incur unintentional dural punctures with large-gauge needles are surprisingly likely to continue to suffer chronic headaches. Treatment with an epidural blood patch does not enhance the risk of chronic back pain. The pathophysiology underlying these symptoms and the best treatment for this syndrome are not known.

MeSH terms

  • Adult
  • Analgesia, Epidural / adverse effects*
  • Analgesia, Epidural / instrumentation
  • Analgesia, Obstetrical / adverse effects*
  • Analgesia, Obstetrical / instrumentation
  • Back Pain / etiology
  • Blood Patch, Epidural
  • Chronic Pain / etiology
  • Dura Mater / injuries*
  • Equipment Design
  • Female
  • Headache Disorders / diagnosis
  • Headache Disorders / etiology*
  • Headache Disorders / therapy
  • Humans
  • Needles
  • New York City
  • Odds Ratio
  • Pain Measurement
  • Pregnancy
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome
  • Wounds, Penetrating / diagnosis
  • Wounds, Penetrating / etiology*
  • Wounds, Penetrating / therapy
  • Young Adult