A Cochrane review [Abstract] 1 included 13 studies with a total of 479 subjects (at least 274 participants were women, with 118 parturients after a lumbar puncture for regional anaesthesia). Caffeine, subcutaneous sumatriptan, oral gabapentin, oral pregabalin, oral theophylline, intravenous hydrocortisone, intravenous cosyntropin and intramuscular adrenocorticotropic hormone (ACTH) were assessed. Iv. caffeine reduced the number of participants with PDPH at one to two hours when compared to placebo. Treatment with caffeine also decreased the need for a conservative supplementary therapeutic option. Treatment with gabapentin vs. placebo reported better visual analogue scale (VAS) scores after one, two, three and four days; treatment with hydrocortisone plus conventional treatment showed better VAS scores than conventional treatment alone at six, 24 and 48 hours and treatment with theophylline showed a lower mean "sum of pain" when compared with placebo. Sumatriptan and ACTH did not show any relevant effect for this outcome. The studies that reported the need for subsequent epidural blood patch (4 trials) did not show significant differences. There were no clinically significant drug adverse events.
Comment: The quality of the evidence is downgraded by imprecise results (limited study size for each comparison).
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