Background: Postdural puncture headache (PDPH) is not uncommon complication of neuroaxial anesthesia and it affects the mother and the newborn. PDPH may be resistant to conservative management and requires intervention. 
Objectives: To evaluate the outcomes of bilateral greater occipital nerve block (GONB) and bilateral suboccipital intramuscular injection in a placebo-controlled study for management of PDPH.
Patients and methods: 50 patients received bilateral saline injection, 32 patients received suboccipital intramuscular injection and 33 patients received GONB using a mixture of 40 mg lidocaine and 8 mg dexamethasoneinjection. Pain severity was assessed using the Numeric Rating Scale at baseline and weekly for 4-wks and monthly for 6-m after block, Pain-induced disability was assessed using the Oswestry Pain Disability Questionnaire (OPDQ) score and analgesic requirements were graded at baseline, 1-, 3- and 6-m after block. The success rate was defined at the end of 6-m follow-up as the frequency of patients who stopped consumption of analgesia and/or had minimal-to-mild disability with OPDQ score of <20.
Results: The success rates were 46.2% depending on number of women had stopped analgesia and 52.3% depending on the OPDQ score and was significantly higher among patients received GONB. Patients' distribution according to satisfaction grade was significantly higher in study groups than control groups with non-significant differences between the study groups.
Conclusion: The applied procedures are effective for reducing pain severity, consumption of analgesics and improving disability. GONB provided significantly higher success rate, but the choice of the procedure may be according to preference of the service provider.