Abdelaal Ahmed Mahmoud A, et al. - In this randomized, controlled, double-blind study, researchers compared the efficacy of neostigmine and atropine (n = 41) vs a saline placebo (n = 44) for treating postdural puncture headache (PDPH) in addition to conservative management of 85 patients with hydration and analgesics. Findings revealed that, only 2 doses of neostigmine/atropine resulted in effective treatment of PDPH. They observed neostigmine could pass the choroid plexus but not the blood–brain barrier. In addition, both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH, were impacted by the central effects of both drugs. These data offer support to previous studies and clinical reports of neostigmine activity.