Positional headache without a previous lumbar puncture: Would a blood patch be useful?

Abstract

You are paged by a neurology colleague who asks you to perform an epidural blood patch (EBP) for a 30-year-old female with severe, debilitating positional headache. You agree to evaluate the patient but do not commit to an intervention yet. The patient has been suffering from acute onset of severe positional headaches for 1 month. She was initially treated by her primary care physician with ibuprofen and hydrocodone, but these medications offered little relief. Her pain is throbbing, severe, and primarily temporal, less so in the frontal and occipital areas. The pain is much worse when she sits and stands and decreases slightly when lying flat. No other symptoms are found. She states that she can no longer care for her 4 children because of debilitating pain.