# Postdural Puncture Headaches in Pediatric Patients: A Review of Options When Repeated Epidural Blood Patches Do Not Work

## TL;DR

This paper discusses a case where a sphenopalatine ganglion nerve block helped a child with a persistent headache after a spinal procedure.

## Contribution

The paper presents a novel use of a J-tip catheter for an SPG nerve block in treating refractory postdural puncture headache in a pediatric patient.

## Key findings

- The patient's headache resolved after a sphenopalatine ganglion nerve block using a J-tip catheter.
- Previous treatments like epidural blood patches and other nerve blocks were ineffective for the patient.
- The J-tip catheter may offer a more effective sympathetic block for intractable postdural puncture headaches.

## Abstract

We present the case of an adolescent with refractory postdural puncture headache (PDPH), whose symptoms resolved with a sphenopalatine ganglion (SPG) nerve block using a J-tip style catheter. Our patient was treated with multiple modalities, including conservative and medical management, multiple epidural blood patches, and different nerve blocks. We discussed different treatments for the PDPH, why each modality did not work, and why our SPG block with a J-tip catheter possibly provided a better sympathetic block in a patient with intractable PDPH for two weeks.