The Impact of Increased Body Mass Index on the Incidence and Severity of Post-spinal Headache after Cesarean Section
Background: Previous studies have been controversial as to the relationship between post-dural puncture headache (PDPH) and body mass index (BMI) in parturient patients. Therefore, we decided to survey this complication in a group of patients whose pregnancies were terminated by cesarean-section under spinal anesthesia. It was hypothesized that patients with higher BMI will have lower incidence of PDPH.
Material and Method: After studying the patients' files and calling them, the demographic information was extracted and recorded. Also, development of PDPH up to three days after cesarean-section in the current delivery and headache score based on 0-10 verbal numeric rating scale (NRS) were documented.
Results: In the current study, 343 parturient patients were analyzed; 164 (47.8%) women were non-obese and the rest (52.2%) were obese (BMI above 30 kg/m2). 91% of the patients had not any past history of PDPH in the previous neuroaxial anesthesia/analgesia. Only 59 patients (17.2%) developed headache after current spinal anesthesia. There was a reverse and significant relationship between pre-cesarean BMI and the post-spinal headache (p-value: 0.016).
Conclusion: The incidence of PDPH was reduced by increased BMI at the time of cesarean-section. In obese patients, the higher intra-abdominal pressure decreases the leakage of CSF from the dural puncture point; thus, by increasing the BMI, the incidence of PDPH is decreased. This study also showed that the severity of PDPH did not significantly change with BMI, weight gain during pregnancy or any other analyzed factors.