Typical description: bilateral, severe, dull, non-throbbing
Features:
(1) usually onset is within a few days after a dural puncture, but may develop immediately after or up to several weeks afterwards
(2) fronto-occipital distribution to the headache
(3) relief if the patient lies down
(4) worse if the person sits, stands up or strains
(5) may be accompanied by nausea, vomiting, neck stiffness, or pain radiating into the neck
(6) may be accompanied by symptoms affecting cranial nerves II and/or VIII
Ocular findings (CN II): photophobia, diplopia, blurred vision
CN VIII: hyperacusis, tinnitus, vertigo, ataxia, hearing loss
NOTE: The CSF pressure should be low in a patient with PDPH. An elevated CSF pressure should suggest another cause.
