Why Don’t All Individuals Who Undergo Dura Mater/Arachnoid Puncture Develop Postdural Puncture Headache?

The physiopathology of postdural puncture headache (PDPH) is most likely multifaceted (1, 2). Understanding the mechanisms through which some subjects develop PDPH may help in the development of PDPH-prevention strategies. In addition, identifying risk factors in susceptible individuals may help develop forms of anesthesia other than spinal anesthesia for preventing dura mater/arachnoid perforation and, subsequently, PDPH (3). Clearly, the main reason and the sine qua non for accounting for PDPH is an excessive loss of cerebrospinal fluid (CSF) from the subarachnoid space after the puncture of both dura mater and arachnoid.