Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH)

Post-dural puncture headache (PDPH) is the most frequent complication of
procedures associated with dural puncture for spinal anesthesia or following accidental dural
puncture during epidural anesthesia. Since invasive treatments have known complications,
pharmacologic management may be preferable. The aim of this study was to evaluate and compare
the efficacy of theophylline and Acetaminophen in treatment of PDPH.
Methods: In this single-blind randomized clinical trial, 60 patients with Class I physical
status according to ASA classification system, who suffered from PDPH were enrolled. Patients in
Theophylline group were received theophylline tablet 250 mg three times per day, and in the other
group acetaminophen 500 mg three times per day was administered. Pain intensity was assessed 2,
6, and 12 hour after drug administration using 0-10 cm Visual Analog Scale.
Results: The main VAS values is significantly lower in theophylline group in comparison
with the acetaminophen group at 2 (5 ± 1.57vs. 5.97 ± 1.27),6 (3.43 ± 1.73vs.4.33 ± 1.49), and
12 (2.67 ± 2.35vs. 4.24 ± 1.97) hours after drug administration (p <0.05). No adverse effects were
reported.
Discussion: Theophylline is a safe and effective treatment for PDPH. It may be tried in PDPH
patients before using any invasive technique. Further investigations studying other Methylxanthines
are recommended as well.