Aminophylline for Post-LP Headache
May 16, 2018
Written by Clay Smith
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Aminophylline 250mg IV helped patients with post-dural puncture headache significantly better than placebo.
Why does this matter?
Post-dural puncture headache is a common complication. It sometimes requires an invasive blood patch to fix. Blood patch remains the most effective, definitive treatment, though it seems some anesthesia teams require an act of Congress to coerce them to do one. Other medications are used, though none have strong evidence. Caffeine is most common, but there are a host of others. What about aminophylline? It makes sense as a phosphodiesterase inhibitor that increases cAMP and likely CSF production.
Blood patch is still the real treatment. But this is a medical option.
This was a multi-center RCT of 126 patients with post-dural puncture headache (PDPH) in China. Those in the aminophylline group had significant improvement in standing headache at 8 hours compared to the placebo group (visual analog score 2.98 vs 5.34). There was improvement beginning at the 30 minute mark, and most of the pain relieving effect took place within one hour. The groups were given either aminophylline 250mg IV or placebo on 2 consecutive days. The problem with this is that the patient would probably not like to stay around the ED for 8 hours to see if they get better. Plus, all patients in this study were admitted for two days, which seems a bit cumbersome and is unrealistic in a US context. Also, would not theophylline given orally be almost as good, given its high bioavailability? It was not used in this study because it was unavailable to the research team. It is very expensive in the US. All told, this looks like a good medical, non-invasive option for PDPH, especially if your anesthesia team is allergic to doing blood patches.
Source
Aminophylline for treatment of postdural puncture headache: A randomized clinical trial. Neurology. 2018 Mar 23. pii: 10.1212/WNL.0000000000005351. doi: 10.1212/WNL.0000000000005351. [Epub ahead of print]
Peer reviewed by Thomas Davis
Quite the snooty "article" attacking anesthesia team members worldwide. Some of us don’t mind doing blood patches if you’ll allow us to teach you how to correctly do lumbar punctures with regard to needle size, bevel orientation, number of passes and patient positioning. Instead of sarcastic nonsense in an attempt at medical literature, you might want to spend more time reading about cooperation with other specialties and improving relationships between departments.