Epidural Saline Plus Intranasal Dexmedetomidine Eased Severe Post-Dural Puncture Headache in One Case

A 37-year-old mother in China who developed one of the most severe headaches possible after an accidental dural puncture during labor analgesia recovered within 48 hours after clinicians combined two non-blood-patch treatments: a continuous epidural infusion of normal saline and intranasal dexmedetomidine. The case, reported by anesthesiologists at Guangdong Medical University Shunde Women and Children’s Hospital and Shunde Hospital of Guangzhou University of Traditional Chinese Medicine in the journal Frontiers in Medicine, offers a possible alternative for patients in whom the standard procedure, an epidural blood patch, is too risky to perform. Post-dural puncture headache, or PDPH, is described in the report as a common complication of obstetric neuraxial anesthesia, and the epidural blood patch is the standard treatment for moderate-to-severe cases.

In this patient, the severe headache began just two hours after delivery, with a sitting pain score of 10 on the numerical rating scale. Cranial magnetic resonance imaging showed narrowing of the suprasellar cistern and inferior displacement of the cerebellar tonsils, findings consistent with intracranial hypotension. Because high fever of 39.2 degrees Celsius and leukocytosis raised concern for possible systemic infection, the team judged an epidural blood patch to be high risk. Instead, they used the epidural catheter that remained in place from labor analgesia to deliver a continuous infusion of normal saline at 10 milliliters per hour.

Alongside the infusion, the patient received empirical ceftriaxone for the suspected infection, non-steroidal analgesia, bed rest, and fluid support. Because the headache persisted, the clinicians added a second element at roughly 24 hours postpartum: intranasal dexmedetomidine, 50 micrograms per dose, given twice daily. The report does not establish a specific mechanism by which the drug relieved the headache, and the authors present the combination as a strategy for selected patients rather than a proven therapy.

The response was stepwise and rapid. The sitting pain score was 10 at 24 hours postpartum, fell to 4 by 36 hours, and reached 0 by 48 hours. Follow-up MRI on postpartum day 5 showed marked improvement in the imaging signs of intracranial hypotension, and no headache recurrence was reported at one-month and three-month follow-up visits.

The authors are careful about what the case can and cannot show. Because the patient received several concurrent interventions, including antibiotics, analgesics, bed rest, fluids, saline infusion, and dexmedetomidine, and because spontaneous improvement is possible in PDPH, no causal link between the combined treatment and the recovery can be drawn from a single case. The report is best read as a feasibility signal: in selected patients with severe PDPH for whom a blood patch is unsuitable or high risk, this combination may be a workable alternative worth studying formally. The authors call for larger studies to evaluate the safety, efficacy, and optimal dosing of the combined approach before it could be recommended more broadly. For now, the take-home message is measured: a retained epidural catheter was turned into a therapeutic tool, an intranasal drug was added on top, and a severe headache resolved in stepwise fashion over two days, with imaging and follow-up documenting recovery. Whether that sequence would work as reliably in other patients, and which component deserves the credit, are questions only larger trials can answer.

Subject of Research: Combined epidural saline infusion and intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension

Article Title: Continuous epidural saline infusion combined with intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension: a case report

Article References: Li, Y., Kang, Q., Liang, H., Zhang, H., Chen, S., Lin, X., & Peng, H. (2026). Continuous epidural saline infusion combined with intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension: a case report. Frontiers in Medicine, 13, Article 1929098. https://doi.org/10.3389/fmed.2026.1929098

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1929098

Keywords: post-dural puncture headache, intracranial hypotension, epidural saline infusion, dexmedetomidine, epidural blood patch, obstetric anesthesia, dural puncture, case report, anesthesiology, labor analgesia, Continuous, epidural