Mahmoud AA, et al. - Experts conducted a randomized, controlled, double-blind study to assess the impact of neostigmine in postdural puncture headache (PDPH). They compared neostigmine and atropine vs a saline placebo for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. Findings suggested efficacy of neostigmine/atropine in treating PDPH after only 2 doses. They noted that neostigmine can pass the choroid plexus but not the blood–brain barrier. Both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH are influenced by the central effects of both drugs. They saw consistency of the findings with previous studies and clinical reports of neostigmine activity.