Persistent headache burden after surgical treatment of post-dural puncture headache: a cross-sectional study

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Background: Post-dural puncture headache (PDPH) may follow intended or unintended spinal dural puncture and is usually self-limiting. In some patients, however, symptoms persist despite epidural blood patches, while postoperative patient-reported data are largely absent. We assessed headache disability, functional status, and psychosocial burden among respondents self-reporting prior surgery for PDPH or dural-puncture-related CSF leak. Methods: An online cross-sectional survey was conducted between February and April 2025. Adults who self-reported prior surgical treatment for PDPH or dural-puncture-related CSF leak were recruited through international online patient support groups. Data were analysed descriptively. Key variables included HIT-6 headache disability, symptom trajectory, occupational status, and psychological symptoms. Results: A total of 136 respondents were included; 74.3% were female, with a median age of 38 years. Diagnostic or therapeutic lumbar puncture was the most frequent reported cause of CSF leak (65.1%), followed by epidural anesthesia (30.6%). Most respondents had undergone a single surgical intervention (73.1%). Complete symptom remission was reported by 9.6% of respondents. Slight and fluctuating improvement was the most frequent trajectory (38.7%; mean HIT-6 61.5, SD 12.0), followed by significant but persistent improvement (27.1%; mean HIT-6 51.5, SD 6.0); 10.4% reported largely unchanged and 5.1% worsened symptoms. Conclusion: Among respondents in this self-selected online cohort, persistent headache burden and psychosocial impairment were frequently reported, whereas complete symptom remission was reported by a minority of respondents. Prospective studies with structured follow-up are needed to better characterize postoperative symptom trajectories.

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