Caffeine for the prevention and treatment of postdural puncture headache: Debunking the myth

Rashmi B. Halker, Bart M. Demaerschalk, Kay E. Wellik, Dean M. Wingerchuk, Devon I. Rubin, Brian A. Crum, David W. Dodick

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


OBJECTIVE: Is caffeine effective in preventing and treating postdural puncture headache (PDPH)? METHODS: The question was addressed with a structured evidence-based clinical neurologic practice review via videoconferencing between 3 academic institutions. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarians, and clinical content experts. A critically appraised topic format was employed, starting with a clinical scenario and structured question. Participant groups at each of the 3 institutions independently devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: Three directly relevant randomized controlled trial articles were selected as the best available evidence for the clinical questions. Two investigated caffeine [oral and intravenous (IV)] as PDPH prophylaxis and 1 (oral) as PDPH treatment. One additional quasirandomized trial (IV) and 1 open-label trial (IV) of caffeine for PDPH treatment were located by reviewing bibliographies. Articles describing the pharmacological basis for caffeine therapy were also identified. No valid pharmacological rationale for caffeine as an antinociceptive agent for PDPH exists. The clinical trials are few in number, small in sample size, methodologically weak or flawed, and either demonstrate no effectiveness, contradictory and conflicting results, or invalid answers. CONCLUSIONS: The wide endorsement for caffeine to prevent and treat PDPH found in textbooks and review articles appears to be unwarranted and insufficiently supported by the available pharmacological and clinical evidence.

Original languageEnglish (US)
Pages (from-to)323-327
Number of pages5
Issue number5
StatePublished - Sep 2007


  • Caffeine
  • Critically appraised topic
  • Evidence-based medicine
  • Postdural puncture headache

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Caffeine for the prevention and treatment of postdural puncture headache: Debunking the myth'. Together they form a unique fingerprint.

Cite this