Theophylline, Versus Sumatriptan and Gabapentin in The Treatment of Post-Dural Puncture Headache

Post-dural puncture headache (PDPH) is a frequent complication of spinal anaesthesia or dural puncture and is an uncomfortable situation for both the patient and the anesthetist.

Theophylline as a form of methyl xanthine, is an adenosine receptor antagonist and can decrease intracranial blood flow and venous enlargement. Evidence shows that intravenous theophylline infusion is a rapid, effective, non-invasive, practical, and low-cost method to treat post-spinal headache.

Sumatriptan is a selective agonist of 5-hydroxytrytamine-like receptors and is used in the treatment of migraine. It has been used in the treatment of PDPH where it may prevent cerebral vasodilation associated with the cerebrospinal fluid (CSF) leak.

Gabapentin is a structural analogue of gamma amino butyric acid; it was used as an anticonvulsant drug for the first time. This drug is now applied in diabetic neuropathy, neuropathic cancer pain and inflammatory injury.

Inclusion criteria

• Age from 21 to 50 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) physical status ≤ II.
• Patient's selection for this study will be based on clinical diagnosis suggesting post-dural puncture headache (PDPH) based on the International Headache Society criteria.
• Patients with numeric rating scale (NRS) of ≥ 5.

Exclusion criteria

• Pregnant women.
• History of; chronic headache, cluster headache, migraine, convulsions, cerebrovascular accident, and previous neurological diseases.
• Signs of meningismus.
• Dysrhythmia.
• Hypertension.
• Ischemic heart disease.
• Hyperthyroidism.
• Peripheral vascular disease (ischemic colitis).
• Liver or renal impairment.
• Use of selective serotonin reuptake inhibitors.
• Use of ergotamine derivatives in the past 24 hours.
• Use of monoamine oxidase inhibitors in the last 2 weeks.
• Use of any kind of opiates.
• Allergy to the study medications and any contraindication of oral intake.