Post-dural Puncture Headache During Bacteraemia: Successful Management With Combined Sphenopalatine Ganglion and Greater Occipital Nerve Blocks

Epidural blood patch (EBP) is considered the most effective interventional treatment for post-dural puncture headache (PDPH), but it is considered a relative contraindication during active bacteraemia because of the theoretical risk of neuraxial seeding. We describe a 26-year-old primiparous woman who developed a typical orthostatic headache after a technically difficult labour epidural analgesia. On postpartum day 4, she developed fever and urinary symptoms; blood and urine cultures grew Escherichia coli, and abdominal imaging subsequently confirmed acute right pyelonephritis with bacteraemia. Brain magnetic resonance imaging (MRI) with venographic sequences excluded cerebral venous sinus thrombosis and other intracranial pathology. After multidisciplinary discussion, we performed bilateral transnasal sphenopalatine ganglion block followed by bilateral ultrasound-guided greater occipital nerve block on postpartum day 6. Headache severity decreased from a numerical rating scale (NRS) of 7/10 to 2/10 within 30 minutes, and the patient was able to resume care of her newborn. She remained symptom-free at hospital discharge and at telephone follow-up 7 and 30 days later. This case supports peripheral nerve blocks as a minimally invasive bridge therapy for PDPH when EBP is contraindicated, deferred or declined, and adds to the limited literature on documented obstetric bacteraemia.