Intravenous Aminophylline Safe and Effective for Postdural Puncture Headache

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Postdural puncture headache is a common complication of lumbar puncture performed for spinal anesthesia or neurologic investigation.
Postdural puncture headache is a common complication of lumbar puncture performed for spinal anesthesia or neurologic investigation.

Intravenous (IV) aminophylline is a safe and effective early treatment for postdural puncture headache, according to a recent study published in Neurology.

This randomized, multi-center, placebo-controlled, double-blind study sought to evaluate the efficacy and safety of IV aminophylline for postdural puncture headache. Individuals recruited for the study were treated at 5 centers in China with procedures requiring dural puncture between August 2015 and October 2016. Inclusion criteria included being age between 18 and 70 years, having postdural puncture headache as defined by the International Classification of Headache Disorders, and reporting a visual analog scale score of ≥5 for the headache. Exclusion criteria included having a history of headache, cardiovascular disease, peptic ulcers, or central nervous system diseases.

The 126 participants who qualified for the study were randomly assigned in a 1:1 ratio to either an aminophylline group or placebo group using computer-based permuted blocks. This randomization occurred within 2 hours of postdural puncture headache diagnosis in order to ensure that treatment occurred within 3 hours of headache onset. Analysis indicated that treatment with aminophylline resulted in significantly lowered pain in comparison with placebo (F =68.09, P < .001) within 30 minutes, and that this improvement remained at the 2-day follow-up. Furthermore, aminophylline treatment resulted in significantly improved Patient Global Impression of Change scores compared with placebo. Adverse events occurred in 4.8% of the aminophylline group compared with 1.6% of the placebo group.

Study investigators conclude, “Our study shows that IV aminophylline injections may be a straightforward, safe, and effective treatment for [postdural puncture headache], especially in the early stages. This makes aminophylline an attractive drug for noninvasively managing [postdural puncture headache].”

Reference

Wu C, Guan D, Ren M, et al. Aminophylline for treatment of postdural puncture headache [published online March 23, 2018]. Neurology. doi: 10.1212/WNL.0000000000005351

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