Routine history and physical examination was performed in every patient with special emphasis on the cardiovascular system to rule out coronary artery disease, hypertension or arrhythmias. Only the patients who agreed to the sumatriptan-Fioricet protocol were included in the case report. Patients experiencing PDPH and who were referred to Henry Ford Hospital pain management center (Detroit, Michigan) between August 1997 and March 1998 were offered two treatment options: EBP or this new sumatriptan-Fioricet protocol. The following case report is presented with a retrospective analysis of the results of this new treatment protocol. The authors used a combination of two migraine medications: sumatriptan (Imitrex, Glaxo-Welcome Pharmaceuticals, USA) and Fioricet (Sandoz Pharmaceuticals Corporation, USA) for the treatment of PDPH.
Various treatment modalities have been tried for post-dural puncture headache (PDPH) among which epidural blood patch (EBP) remains as the “gold standard.” However EBP has its own limitations and complications-the procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space (see discussion section for contraindications of EBP.)
The resulting leakage reduces the spinal fluid pressure to the extent that the membrane at the base of the skull, separating spinal and brain fluid reservoirs, stretches and triggers adjacent nerves and thereby causing headaches whose severity correlates to the degree of pressure imbalance. Post-dural puncture headache (PDPH) may occur following any procedure in which a needle pierces the dura membrane of the spine and subsequently causes spinal fluid to leak out through the puncture hole.