الفهرس 
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Abstract
PDPH is the most common complication after SA. The postulated cause of the headache is loss of CSF in the epidural space through the dural puncture site which leads to decrease in CSF pressure. A second possible cause is the sudden decrease in CSF pressure which leads to vasodilation of the intracranial vessels (to maintain a constant intracranial volume),which resembles the pathophysiology of vascular headache.
90% of PDPHs occur within 3 days of the procedure and 66% start in the first 48 h Finally, the headache should resolve spontaneously within 1 w or within 48 h of receiving effective treatment of the CSF leak usually by EBP. Current treatment for PDPH involves complete bed rest, hydration, analgesics, oral or intravenous caffeine, sumatriptan, ACTH, corticosteroids, and EBP.
The aim of this study was to compare between the prophylactic effect of each of aminophylline, gabapentin, and neostigmine on the occurrence of PDPH.
Aminophylline mechanism underlying the treatment effects in PDPH remains unclear. The mechanism could be related to specific factors. Firstly, it could block adenosine, contract intracranial blood vessels and block the transmission of pain through noci-receptors. Secondly, it could inhibit phosphodiesterase and raise the intracellular cAMP concentration. Thirdly, it could suppress the Ca uptake by the endoplasmic reticulum in endothelial cells, stimulate Ca-K pumps, and increase the secretion of CSF.
As regards neostigmine, it was found to have an initial direct stimulatory action on depolarization of cerebrospinal ganglia leading to cerebral vasoconstriction which antagonizes the cerebral vasodilation occurring with PDPH and explains the fast improvement of headache.
Gabapentin is widely used for the treatment of different types of headache including PPDH. It has been indicated in some studies that α2-delta type voltage-dependent Ca channels are effective in this pain phenomenon. Gabapentin has binding affinity for this type of Ca channels; therefore, it can reduce PDPH.
75 females undergoing elective CS delivery completed the study and were divided into 3 groups:
- group A: 25 patients received 250 mg aminophylline IV immediately after delivery of the infant.
- group B: 25 patients received IV neostigmine of dose 20 µg/kg added to atropine of dose 10 µg/kg immediately after delivery of the infant.
- group C: 25 patients received 900 mg oral gabapentin in the form of capsules 300 mg/8 hours
As regards incidence of PDPH, there was significant difference among in group A than in group B &C ; 2 cases in group A (8%), 10 cases in group B (40%) and 6 cases in group C (24%).
As regards onset of PDPH, there was significant delay in group C than group A and in group C than B.
As regards duration of PDPH, there was highly significant reduction in group A than group B and group C and there was significant reduction in group C than group B.
As regards total dose of analgesic requirement, there was significant reduction of dose of paracetamol in group A than B and C, and in group C than B.
As regards VAS, there was no significant difference in the three groups at 3 h. There was significant difference among the three groups at 6, 12, 24, 36, 48 and 72 h.