Grading of severity of postdural puncture headache after 27-gauge Quincke and Whitacre needles

Background: Small-gauge needles are reported to have a low incidence of complications. Pencil-point needles are associated with a lower frequency of postdural puncture headache (PDPH), but a higher failure rate than Quincke needles. Methods: The incidence of PDPH was investigated in 200 patients under the age of 45, undergoing day-care surgery, after spinal anaesthesia with either 27-gauge Quincke or Whitacre needle. The severity of headache was graded as I (mild), II (moderate) or III (severe) using a grading system based on the visual analogue scale (VAS) associated with a functional rating (FG). Results: The frequency of PDPH following the Whitacre needle was 0% and 5.6% after the Quincke needle (P=0.05). Two PDPHs were assessed as grade III, and three as grade II. All PDPHs occurred when the Quincke needle bevel was withdrawn perpendicular to the dural fibres following parallel insertion. No PDPH occurred when the bevel was inserted and removed parallel to the dural fibres (P<0.05). There was no statistical difference (P>0.8) in the incidence of PDPH and postdural puncture-related headaches (PDPR-H) in patients with recurrent headaches or migraine compared to patients with no previous history of headaches. Conclusions: We conclude that the 27-gauge Whitacre needle is the 'needle of choice' in patients with normal body stature. The incidence of PDPH following Quincke needles may not only be affected by the direction of the bevel during insertion but also during removal. Statistically, there was no gender variation in PDPH in this study (P=0.5). A previous history of recurrent headache or migraine does not predispose to PDPH.