Evaluation of the Effectiveness and Tolerance of Tetracosactide Synacthen® in the Treatment of Post Dural Puncture Headaches (ESYBRECHE)
Evaluation of the Effectiveness and Tolerance of Tetracosactide Synacthen® in the Treatment of Post Dural Puncture Headaches (ESYBRECHE)
The aim of the study is to assess the efficacy and safety of Synacthène® versus placebo in
 the treatment of post-dural puncture syndrome in patients receiving epidural analgesia,
 spinal analgesia, or combined spinal-epidural analgesia for labour.
Inclusion Criteria:

 All women who received epidural, spinal, or combined spinal-epidural labour analgesia and
 presenting post-dural puncture headache:

 -  Intense: with ≥3 / 10 numerical rating pain scale

 -  Appearing within 5 days after delivery

 -  Aggravating in sitting or standing position and / or improving supine

 -  Can be associated with one of the following criteria: tinnitus, nausea, photophobia,
 neck stiffness or pain, hearing loss

 -  After exclusion of clinically differential diagnoses (preeclampsia or eclampsia,
 cerebral venous thrombosis, migraine)

 -  Age greater than or equal to 18 years

 -  Affiliation to social security scheme

 -  Inform Consent signed after oral and written information

 Exclusion Criteria:

 -  Presence of diplopia (indication of immediate blood patch)

 -  Contraindication to ACTH or Synacthène® (unbalanced hypertension, uncontrolled
 diabetes, uncontrolled psychosis, infectious viral disease state or evolving)

 -  Processing of Torsade de Pointe provider (astenizole, bepridil, erythromycin IV,
 halofantrine, pentamidine, sparfloxacin, sultopride, terfenadine, vincamine)

 -  Live vaccine in the months prior to inclusion

 -  Hypersensitivity to Synacthène®

 -  Patient who have previously received Synacthène® after delivery

 -  Contraindication to blood patch (fever or leukocytosis, HIV or HCV patient)

 -  Eclampsia or preeclampsia during this pregnancy

 -  Patient who have received prophylactic blood patch (at diagnosis of Accidental Dural
 Puncture)

 -  Minor under 18 or protected

 -  Psychological disorders do not allowing informed consent

 -  Refusal of participation in the study or participation in another ongoing
 interventional study

 -  Withdrawal of consent