{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:09:37Z","timestamp":1790701777601,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T00:00:00Z","timestamp":1674000000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2023,1]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To assess the effectiveness and safety of a novel management pathway in the obstetric population presenting to a pain medicine clinic with persistent headache after accidental dural puncture (PHADP).<\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Accidental dural puncture (ADP) can result in headaches that persist for months to years. These headaches can be a therapeutic challenge, often cause severe disability, and management pathway remains obscure.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Obstetric patients with PHADP referred to a pain medicine physician were prospectively followed up in a longitudinal audit of a novel management pathway. ADP reports dated from 2008 until 2019. Initial management included brain imaging and pharmacological agents. Patients who failed to respond were offered greater occipital nerve (GON) block with depot methylprednisolone followed by pulsed radiofrequency (PRF) treatment. A headache diary was completed for 4\u2009weeks prior to commencing treatment and maintained for 24\u2009weeks following an intervention. Data collected included use of epidural blood patch to manage postdural puncture headache, past history of headache, severity of headache, duration of persistent headache, low back pain, and employment status.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Over the 9\u2010year period, a cohort of 54 obstetric patients with PHADP with a 16\u2010gauge Tuohy needle were reviewed in the pain clinic. Forty patients presented with chronic daily headache (40\/54, 74%). Brain imaging did not reveal any sign of intracranial hypotension in 50 patients (50\/54, 93%). Mean follow\u2010up period was 5.7\u2009years. Two patients were lost to follow\u2010up (2\/54, 4%). Pharmacological management was effective in 17 patients (17\/52, 33%). Medical management failed to improve symptoms in 35 patients (35\/52, 67%), and they were offered GON block. Fourteen (14\/35, 40%) patients refused the intervention. Nerve block was performed in 21 patients and produced durable benefit lasting 24\u2009weeks in 18 patients (18\/21, 86%). Three patients underwent PRF treatment to GONs and all three (100%) reported durable benefit. At final follow\u2010up, mean monthly headache frequency was 5.9 for the medical management group, 8.6 for the refused nerve block group, and 4.1 in patients who received GON treatment (\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n ADP can cause chronic headaches that persist beyond 3\u2009years. Interventions targeting the GONs appear to have a role in the management of PHADP.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/head.14447","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T06:54:00Z","timestamp":1674024840000},"page":"71-78","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Management and outcomes of persistent headache after accidental dural puncture in the obstetric population: A 9\u2010year prospective audit"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5667-0885","authenticated-orcid":false,"given":"G.","family":"Niraj","sequence":"first","affiliation":[{"name":"Clinical Research Unit in Pain Medicine University Hospitals of Leicester NHS Trust Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Critchley","sequence":"additional","affiliation":[{"name":"Clinical Research Unit in Pain Medicine University Hospitals of Leicester NHS Trust Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,18]]},"reference":[{"issue":"5","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1093\/bja\/aeg231","article-title":"Post\u2010dural puncture headache: pathogenesis, prevention and treatment","volume":"91","author":"Turnbull DK","year":"2003","journal-title":"Br J Anaesth"},{"issue":"8","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/anae.15491","article-title":"Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study","volume":"76","author":"Niraj G","year":"2021","journal-title":"Anaesthesia"},{"key":"e_1_2_10_4_1","first-page":"1107","article-title":"Long\u2010term morbidities following unintentional dural puncture in obstetric patients: a systematic review and meta\u2010analysis","volume":"79","author":"Mims SC","year":"2022","journal-title":"J Clin Anesth"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"The International Classification of Headache Disorders: 3rd edition (7.2.1)","volume":"38","author":"Headache Classification Committee of the International Headache Society (IHS)","year":"2018","journal-title":"Cephalalgia"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s11916-003-0036-y","article-title":"The trigeminocervical complex and migraine: current concepts and synthesis","volume":"7","author":"Bartsch T","year":"2003","journal-title":"Curr Pain Headache Rep"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1016\/j.pain.2013.07.021","article-title":"Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading 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The long\u2010term consequences of postdural puncture headache and the role of unintended dural puncture","volume":"61","author":"Barad M","year":"2021","journal-title":"Headache"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.14447","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/head.14447","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.14447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T11:00:19Z","timestamp":1762081219000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.14447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/head.14447"],"URL":"https:\/\/doi.org\/10.1111\/head.14447","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"2022-08-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}