Use of cosyntropin for treatment of refractory post dural puncture headache (PDPH): Case report and a suggested algorithm

Postdural Puncture Headache (PDPH) is a frequent complication of neuraxial blockade. Use of ACTH or its synthetic analogs for the treatment of PDPH has been reported in the literature since 1994. We describe a case of refractory PDPH in a 36 year old female despite two epidural blood patches (EBPs). Evidence-based algorithmic management of PDPH has never been reported in Anesthesiology literature. Based on the available evidence we developed an opinion-based algorithm for management of PDPH. The associated case report highlights the role of ACTH and the importance of algorithmic management of PDPH. We hope to incite a debate within the anesthesiology community on the role of ACTH and the need for evidence-based algorithmic management of PDPH.