Postdural Puncture Headache Relief With Aminophylline and SPGB

Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population; The gold standard treatment for PDPH is epidural blood patch, which is an invasive and risky procedure.

The trans-nasal sphenopalatine ganglion (SPG) block and intravenous aminophylline are promising options for PDPH. So the investigators designed this randomized, double-blind study to compare Sphenopalatine ganglion block (SPGB) and aminophylline in the efficacy and safety management of PDPH.

Inclusion criteria

• 18 - 40 years old female.
• ASA I -II according to the American society of anesthesiologists.
• Spinal anesthesia with 22G Quincke needle for cesarean section.
• PDPH was defined according to the international classification of headache disorders, 3rd edition criteria (ICHD-3) as:

• Headache occurring within 5 days of a lumbar puncture.
• Orthostatic headache that significantly worsens soon after sitting upright or standing and/or improves after lying horizontally usually accompanied by neck pain, tinnitus, changes in hearing, photophobia, and/or nausea.
• Exclusion of other causes such as hypertension, preeclampsia, tension headache, migraine, etc.

Exclusion criteria

• A history of headaches that could interfere with the PDPH diagnosis,
• A history of central nervous system diseases, including intracranial hemorrhage, seizures, intracranial hypertension, or hydrocephalus
• A history of cardiovascular diseases, including coronary heart disease, arrhythmias, or hypertension.
• A history of allergy to or any contraindication for using Aminophylline.
• Coagulopathy.
• Nasal septal deviation, polyp, or nasal bleeding.
• General anesthesia after failed spinal anesthesia.