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Classification and Severity Grades of Corbey et al for Post-Dural Puncture Headache

Purpose: To evaluate a patient with a headache following dural puncture using the classification and grades of Corbey et al.

Description

Corbey et al used a classification and grading system for evaluating patients with post-dural puncture headaches (PDPH). The authors are from Grindsted Sygehus in Denmark.


Headache Classification

 

Post-Dural Puncture Headache (PDPH):

(1) aggravated by sitting or standing

(2) relieved by lying flat

(3) mainly frontal or occipital

(4) may be accompanied by generalized (nausea, dizziness, neck stiffness) and/or localized (auditory phenomenon, visual hallucinations) symptoms

 

Possible PDPH:

(1) not aggravated by changes in position (I am uncertain if relief by lying flat is included in this)

(2) if the patient has habitual headaches, then the current headache does not resemble them

(3) otherwise similar to PDPH

 

Migraine headache: not defined, but I would assume this would be an habitual headache with certain characteristic features for the patient (like aura).

 

Non-specific headache: headache not fulfilling any of the above criteria.

 

Grading Severity

 

Parameters:

(1) Visual Analogue Scale (VAS): from 0 (no pain) to 10 (worst pain imaginable)

(2) functional grade

(3) relief

 

Clinical Function

Functional Grade

headache does not interfere with normal activities

1

periodic bedrest is needed to relieve the headache

2

unable to sit-up and eat

3

 

 

VAS Score

Functional Grade

Relief

Severity Grade

1 to 3

1

 

I

4 to 7

2

 

II

8 to 10

3

relieved by bedrest and non-opioid analgesics

IIIa

8 to 10

3

not relieved by bedrest and non-opioid analgesics

IIIb

 

Limitations:

• Patients differ in how they use the VAS scale (i.e., my pain 5 may differ from yours) and how they respond to pain. This means that it is possible that a person with a VAS score of 6 might be unable to situp (FG 3), or a VAS score of 9 be functionally unaffected.


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Specialty

Objective

ICD-10