Mirtazapine vs Sumatriptan in the Treatment of Postdural Puncture Headache Following Obstetric Surgery Under Spinal Anesthesia

Abstract Background Postdural puncture headache (PDPH) is a potential complication after spinal anesthesia caused by traction on pain-sensitive structures from low cerebrospinal fluid pressure (intracranial hypotension) following a leak of cerebrospinal fluid at the puncture site. Symptoms of this condition include a bilateral frontal or occipital headache that is worse in the upright position, along with nausea, neck pain, dizziness, visual changes, tinnitus, hearing loss, or radicular symptoms in the arms. Objective To compare the efficacy of mirtazapine with that of sumatriptan in the treatment of postdural puncture headache after obstetric surgery under spinal anesthesia. Patients and Methods This clinical study was carried out at Ain Shams University Hospitals from 15 November 2021 to 15 September 2023. 210 women were enrolled in the study and underwent obstetric surgery under spinal anesthesia. Results In this study, Mirtazapine and Sumatriptan significantly relieved PDPH and its associated symptoms. This improvement was evident after 72 hours of administration of the drugs in both groups. Clinically significant drop of VAS for headache to < 4 was reached in both study groups; So, both treatments showed similar effectiveness from the sixth hour onwards. Conclusion The current study concluded that Mirtazapine was as effective as sumatriptan in treatment of postdural puncture headache after caesarean sections under spinal anesthesia with the superiority of Mirtazapine in its associated anti emetic effects.