Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches (PDPHs). This terminology has been officially adopted in the International Classification of Headache Disorders and is used in this chapter. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an alternate term, meningeal puncture headache (MPH), which readers may increasingly encounter. It is also important to acknowledge that references to “dural puncture” throughout the medical literature (including this chapter) actually describe puncture of the dura-arachnoid and are more correctly termed and thought of as “meningeal puncture.”
Regardless of terminology, the PDPH is well known to the many clinicians whose practice includes procedures that access the subarachnoid space. Yet, our understanding of this serious complication remains surprisingly incomplete. This chapter summarizes the current state of knowledge regarding this familiar iatrogenic problem as well as the closely related topics of accidental, or unintentional, dural puncture (ADP or UDP, respectively), and the epidural blood patch (EBP).