The incidence of PDPH is 0.5-1% and is often higher in teaching hospitals. It may occur at the time of epidural insertion or be caused later by catheter migration into the intrathecal space. The clinical presentation is of an occipital headache which may radiate anteriorly, aggravated by sitting and possibly associated with nausea, photophobia and, rarely, diplopia resulting from stretching of the Vlth cranial nerve as it passes through the dura. The differential diagnosis of meningitis, subarachnoid haemorrhage or even cerebral space-occupying lesions should be considered and excluded by history and simple clinical examination.
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