Intravenous Adrenocorticotropic Hormone in the Treatment of Post-Dural Puncture Headache: A Case of Refractory to Multiple Epidural Patch

Abstract

Post-dural puncture headache (PDPH) is an iatrogenic complication. It can disturb daily activities and particularly breastfeeding after delivery. Epidural blood patch (EBP) is still a last resort and treatment of choice after administration of certain proposed drugs. The use of intravenous (IV) adrenocorticotropic hormone (ACTH) has been suggested for treatment even in refractory cases in a literature review. EBP is an invasive procedure and not desirable for most patients. The associated case report highlights the important role of ACTH in alleviating PDPH and its priority for administration prior to EBP. We hope this report prompts the anesthesiology community to provide a more evidence-based approach to the role of ACTH in the better management of PDPH.