Headache From Epidural for Labor May Up Subdural Hematoma Risk

The presence of presumed postdural puncture headache after neuraxial anesthesia (epidural or spinal) in childbirth is associated with an increased risk for being diagnosed with an intracranial subdural hematoma, according to a study published online Sept. 16 in JAMA Neurology.

Albert R. Moore, M.D., from McGill University in Montreal, and colleagues examined the correlation between postdural puncture headache and postpartum intracranial subdural hematoma in a cohort of 22,130,815 patients and deliveries.

The researchers identified 68,374 postdural puncture headaches, for an overall rate of 309 per 100,000. A total of 342 cases of subdural hematoma were identified, for a rate of 1.5 per 100,000 women. One hundred of these cases were in women with postdural puncture headache, for a rate of 147 hematoma cases per 100,000 deliveries. The unadjusted absolute risk increase was 145 subdural hematoma cases per 100,000 deliveries for postdural puncture headache. Postdural puncture headache had an odds ratio for subdural hematoma of 199 and an adjusted absolute risk increase of 130 per 100,000 deliveries after adjustment for confounders.

"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."

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