OBJECTIVE: This Evidence-Based Case Management article evaluates and grades the 
evidence for two anesthesiology-related interventions: prophylaxis after 
unintentional meningeal puncture and treatment of spontaneous intracranial 
hypotension (SIH).
METHODS: A search was made of relevant English language clinical studies or 
reports pertinent to the topic of low-pressure headache, but excluding the 
treatment of meningeal puncture headache.
RESULTS: Thirty-seven case reports, case series, and clinical trials were 
included to develop the best available evidence-based recommendations for the 
prophylaxis of unintentional meningeal puncture and for the treatment of SIH.
CONCLUSION: The highest quality randomized controlled trials suggest that 
prophylactic epidural blood patch (EBP) does not reduce the incidence of 
headache after unintentional meningeal puncture. The weight of existing 
literature supports EBP as an initial treatment of SIH, although its 
effectiveness does not approach that seen when EBP is used to treat meningeal 
puncture headache.