Abstract: This study compared the frequency and severity of Post Dural Puncture Headache (PDPH) in obstetric patients using 27G Quincke and Whitacre spinal needles in midline and par median approaches. The study was comparative, randomized, double-blind and interventional carried out at Al Hamra Hospital Ministry of Health, Jeddah, KSA. Eight hundred full term pregnant women, ASA I-II, at age of 18-44 years old, scheduled for elective caesarean section, under spinal anesthesia, were randomized into four groups: Group I (27G Quincke spinal needle midline approach), Group II (27G Quincke spinal needle par median approach), Group III (Whitacre spinal needle midline approach) and Group IV (27G Whitacre spinal needle, par median approach). Spinal anesthesia was performed with 2.4-3 mL 0.5% hyperbaric bupivacaine, at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following caesarean section. Frequency and severity of post PDPH were recorded and treated by conventional treatment. All data were analyzed using SPSS-17. The frequency of PDPH following the use of 27G Quincke spinal needle midline approach (Group I) was 3.0% (6/200), 27G Quincke spinal needle par median approach (Group II) was 2.0% (4/200), 27G Whitacre spinal needle midline approach (Group III) was 1.5% (3/200) and 27G Whitacre spinal needle, Paramedian approach (Group IV) was 0.0% (0/200). The PDPH was mild in two patients, moderate in three patients and severe in one patient (Group I). It was mild in three and moderate in one patient in Group II, it was only mild in three patients in Group III and no any cases reported in Group IV. Also severe PDPH did not occur in Groups II, III and IV. Most of the patients with PDPH developed on 1st and 2nd postoperative day, only one case developed in the third day. When using a 27G Whitacre spinal needle in par median approach, the frequency of PDPH was significantly lower than when the same needle used in midline approach or 27G Quincke needle in bath approaches. None of the thirteen patients suffered from PDPH required an epidural blood patch. All symptoms were relieved by conventional means in all patients. Day of onset of PDPH was the same in all groups.