Headache after Epidural administration for labor may up Subdural Hematoma risk

Canada: Women with postdural puncture headache associated with neuraxial anesthesia in childbirth are at an increased risk of intracranial subdural hematoma, finds a recent study published in the JAMA Neurology journal.

Women giving childbirth have high rates of dural puncture secondary to neuraxial anaesthesia and are at high-risk for a resulting headache. But the certainty of the association between postdural puncture headache and subsequent intracranial subdural hematoma is still not known.

Albert R. Moore, McGill University, Montreal, Quebec, Canada, and colleagues determined the association of postdural puncture headache with postpartum intracranial subdural hematoma.

The researchers used hospital discharges recorded in the US Agency for Healthcare Research and Quality National Readmission Database for women (n=22,130,815) who experienced childbirth from January 2010 to December 2016. Patients were included if they had been admitted for childbirth, had 2 months of follow-up data, and did not receive a diagnostic lumbar puncture. Only the first delivery for a calendar year was studied. Data were analyzed from January 2018 to June 2019.

Key findings of the study include:

• Exclusion of repeated deliveries (n = 28 423), deliveries without 2 months of follow-up data (n = 4 329 621), and deliveries with a diagnostic lumbar puncture (n = 9334) resulted in a final cohort of 22 130 815 patients and deliveries.


• For the cohort, the mean (SD) age was 28.1 (6.0) years, and there were 68 374 postdural puncture headaches, for an overall rate of 309 per 100 000.


• There were 342 cases of subdural hematoma identified, indicating a rate of 1.5 (95% CI, 1.3-1.8) per 100 000 women. Of these, 100 cases were in women with post–dural puncture headache, indicating a rate of 147 hematoma cases per 100 000 deliveries in this subgroup.


• Postdural puncture headache had an unadjusted absolute risk increase of 145 subdural hematoma cases per 100 000 deliveries.


• After adjusting for confounders, postdural puncture headache had an odds ratio for subdural hematoma of 199 and an adjusted absolute risk increase of 130 per 100 000 deliveries.

"These findings are in agreement with multiple case reports that link these conditions," the authors write. "Further research is needed to establish if this association is causal for this rare outcome."

To read the study in detail log on to doi:10.1001/jamaneurol.2019.2995