Agent

Mechanism of Action

Route

Effect on PDPH

Adverse Effects

Opioids

Interact with opioid receptors in the central nervous system.

Oral/IV

Pain relief

Nausea and Vomiting

Caffeine

Central nervous system stimulant, reversibly blocks cerebral adenosine receptors which lead to vasoconstriction of dilated cerebral blood vessels.

Oral/IV (300 - 500 mg) once or twice daily. Single oral dose for mild PDPH was proved to be safe [47] . Caffeine Sodium Benzoate as an IV Bolus/Infusion was proved to be 75% - 80% effective [48]

Temporary pain relief

Return of headache 48 hr after the IV administered dose

Sumatriptan

Serotonin type 1-d receptor agonist, vasoconstriction of intracranial blood vessels.

Subcutaneous

Variable results: a few case reports have reported improvement of symptoms [49] while clinical trials have proved inefficacy [50] [51]

Pain at the site of injection

Chest tightness

Caution in patients with Ischemic Heart Disease

Expensive drug