A Case of Postdural Puncture Headache after Cesarean Section Successfully Treated with Caffeine

Abstract

A 31-year-old woman underwent Cesarean section for a low-lying placenta under combined spinal and epidural anesthesia. Despite uneventful spinal anesthesia and epidural catheter insertion, she developed intense occipital headache which worsened with adoption of upright posture on the day after surgery, and a diagnosis of postdural puncture headache was made. Bed rest, non-steroidal anti-inflammatory drugs, intravenous infusion of solutions and continuous epidural infusion of normal saline were ineffective. On postoperative day seven, intravenous caffeine 200 mg, three times a day, was started, which effectively alleviated her headache and enabled her to walk. No symptoms of caffeine intoxication were detected in the newborn fed with breast milk. Administration of caffeine was continued until postoperative day 12 and it was replaced by oral loxoprofen. She was discharged from the hospital on postoperative day 13. Caffeine is safe and effective for treating postdural puncture headache accompanied with spinal/epidural anesthesia for Cesarean section.