Factors Associated with Post-Dural Puncture Headache Following Spinal Anesthesia at Hupzaga Mahajanga (Madagascar)

Introduction: Post-dural puncture headache is a common complication of spinal anesthesia and may impair postoperative recovery. This study aimed to evaluate the frequency of this headache and identify associated factors among patients undergoing spinal anesthesia at University Hospital Professor ZAFISAONA Gabriel Mahajanga.

Methods: This was a prospective case-control study conducted over a ten-month period from June 1, 2023, to March 31, 2024. All patients older than 15 years who underwent surgery under spinal anesthesia were included. Cases were defined as patients who developed post-dural puncture headache within seven postoperative days, whereas controls were patients without headache. Associations were assessed using odds ratios (OR) with 95% confidence intervals.

Results: Among the 427 patients who underwent spinal anesthesia, 34 (7.96%) developed post-dural puncture headache. The mean age was 26.82 ± 6.01 years, with a female predominance. Emergency obstetric and trauma surgeries were the most frequently performed. Headaches were mainly frontal, of early onset, and mild to moderate intensity. The use of Quincke® needles (OR = 4.40; 95% CI: 1.62–12.10; p < 0.01), G22 needles (OR = 4.64; 95% CI: 1.08–19.39; p = 0.026), and two or more puncture attempts (OR = 3.12; 95% CI: 1.10–8.87; p = 0.027) were significantly associated with the occurrence of PDPH.

Conclusion: Post-dural puncture headache was a frequent complication of spinal anesthesia. The use of atraumatic needles and reduction in the number of puncture attempts could help decrease its incidence.