Successful treatment of dural puncture headache with epidural saline infusion after failure of epidural blood patch. Case report.

A case is presented of a 30-year-old female with a 4-month history of post-lumbar puncture headache (PLPHA) resulting from an accidental dural puncture during an attempted epidural anesthetic for cesarean section. Epidural blood patches were attempted at 4 days and 3 months post-lumbar puncture, but were unsuccessful. At 4 months post-lumbar puncture, a 24-h epidural saline infusion relieved the PLPHA for 48 h, but the headache returned. Finally, a second epidural saline infusion was done, followed by an epidural blood patch, which permanently cured the PLPHA. Follow-up to 4 months showed no return of the PLPHA. The rationale for epidural blood and saline patches is discussed.