Aims and Objectives: To compare the incidence of Postdural Puncture Headache (PDPH) with spinal anesthesia using median and paramedian approach in pregnant women undergoing elective cesarean section. Materials and Methods: One Hundred patients with American Society of Anesthesiologists Physical Status I and II scheduled for elective cesarean section under spinal anesthesia were randomly allocated into two groups with fifty patients each. Group M: Received the subarachnoid block with median approach using 25G Quinke spinal needle and 10 mg Inj Bupivacaine heavy 0.5% at L3–L4 intervertebral space. Group P: Received the subarachnoid block with paramedian approach using 25G Quinke spinal needle and 10 mg Inj Bupivacaine heavy 0.5% at L3–L4 intervertebral space. Patients were assessed for hemodynamic changes, sensory and motor block and adverse effects in the intraoperative period. Postoperatively patients were monitored for PDPH, low backache, nausea, vomiting, first attempt success rate and the need for rescue analgesia. Results: The incidence of Postdural Puncture Headache (PDPH) was 18% in Group M as compared to 4% in Group P with p - value of 0.025 which is statistically significant. While the incidence of low backache was 14% in Group M as compared to 0% in Group P with p - value of 0.006 which is also statistically significant. Conclusion: The paramedian approach of subarachnoid block has lesser tendency to cause post dural puncture headache and low backache as compared to median approach in patients undergoing elective caesarean section.