• Carlos J Roldan, Matthew Chung, Correa Mc, J Cata, and Huh B.
• Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, South America. Electronic address: croldan@mdanderson.org.
• Am J Emerg Med. 2020 Dec 1; 38 (12): 2625-2628.

ObjectivePost dural puncture headache (PDPH) is a common complication in patients following diagnostic or therapeutic lumbar puncture, procedures requiring epidural access, and spinal surgery. Epidural blood patch (EBP), the gold standard for the treatment of this pathology requires training not provided to emergency physicians. In addition, the presence of concomitant pathology and abnormal laboratory values are contraindications to perform EBP. In presence of these limitations, we sought for a non-interventional management of PDPH utilizing high-flow oxygen and pro-serotonin agents. We reviewed the mechanism of action of this therapy METHODS: To illustrate our proposal, we report a series of twelve consecutive patients with PDPH treated with high-flow oxygen therapy at 12 L/min via a non-rebreathing mask and intravenous metoclopramide.ResultsAll patients were treated with this conservative therapy, no adverse reactions were observed. After the intervention, the headache resolved without further indications for PDPH.ConclusionOur series suggests that combining high-flow oxygen and pro-serotonin agents such metoclopramide in the ED might be a feasible option as effective as the invasive methods used in treating PDPH. This therapy appears to be efficient and to minimize risk, cost and side effects. It presents an easily accessible alternative that should be considered when PDPH is not a viable option.Copyright © 2020 Elsevier Inc. All rights reserved.

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