Postdural puncture headache (PDPH) is a common complication after spinal anesthesia. The role of pregabalin and hydrocortisone in the treatment of PDPH is unclear. The aim of this work is to assess and compare the efficacy of both drugs in severe cases of PDPH after spinal anesthesia for elective cesarean section.

The study will be done on 30 patient with PDPH with VAS score ≥ 5 after spinal anesthesia for elective cesarean section. Patients will be divided into three groups: Control group (group C):will receive conventional treatment in the form of good oral hydration, 500 mg of acetaminophen plus 65 mg of caffeine oral tablets thrice daily, 3 cups of coffee daily, 50 mg of diclofenac potassium oral tablets twice daily and recumbent positioning for 48 hours. Pregabalin group (group P): will receive the conventional treatment plus 100 mg of pregabalin oral tablet every 8 hours for 48 hours. Hydrocortisone group (group H): will receive the conventional treatment plus 100 mg of hydrocortisone IV every 8 hours for 48 hours. The three groups will be compared regarding the headache intensity using a visual analog scale.

Inclusion Criteria:

• Patients who underwent elective cesarean section under spinal anesthesia.
• Patients aged 18 to 40 years old.
• Patients classified as ASA I or II.

Exclusion Criteria:

• Patients with known sensitivity to any of the used drugs.
• Patients classified as ASA III or more.
• Preeclampsia.
• Patients with a history of chronic headache or migraine Patients receiving pregabalin for chronic pain.

The study group is the pregnant females undergoing cesarean section