Oral Ergotamine versus Theophylline as a Trial in Treatment of Low Tension Post Spinal Headache

Abstract
Background: Spinal anesthesia with local anesthetic agents is extensively used. It provides excellent pain relief as com-pared to intravenous or epidural route. But spinal anesthesia has some complications; one of them is post spinal headache. Which may range from mild to severe, So there were many trials for treatment of this headache.
Aim: Our aim was to study the efficiency of oral ergot-amine versus theophylline in treatment of low tension post spinal headache.
Material and Methods: This study was carried out on 90patient, 18-40 years, ASA I, scheduled for lower extremity and lower abdominal surgery under spinal anesthesia. Patients were randomized into three equal groups (30 patients in each group): Group 1: Patients received treatment in the form of (ergotamine 1mg/8 hours orally+ paracetamol 500mg/8 hours orally). Group 2 Patients received treatment in the form of (theophylline 250mg orally/8 hours+ paracetmaol 500mg/8 hours orally). Group 3 Patients received treatment in the form of (paracetamol 500mg/8 hours orally). The following param-eters were compared between the 3 groups: Patients will be asked for headache evaluation in sitting position in the fol-lowing times: Before medication, after 1 hour of medication then every 6 hours till complete resolution of headache, Onset of relieve of headache, Duration of treatment, Any side effects of each studied drugs and Patient satisfaction.
Results: As regard headache evaluation using Numerical rating scale (NRS), theophylline group showed significant decrease in NRS when compared to ergotamine group and paracetamol group. Also mean duration to complete pain relieve showed significant decrease in theophylline group when compared to ergotamine group and paracetamol group with more patient satisfaction while, as regard onset of pain relieve, ergotamine group showed significant decrease when compared to theophylline group and paracetamol group respectively. There were no side effects recorded in the three groups.
Conclusions: Adding either ergotamine or theophylline to paracetamol were more effective in decreasing intensity of PDPH pain than using paracetamol alone without side effects.
In comparsion with ergotamine and paracetamol, theophylline was more effective due to lower Numerical rating scale, shorter duration till complete pain relieve with better patient satisfaction.