Highlighter is on. Drag to highlight text. Click a highlight to remove it.
ALL / Neurology

Post-lumbar puncture headache

Post-lumbar puncture headache

Headache following lumbar puncture (LP) occurs in approximately one-third of patients. The pathophysiology of is unclear but may relate to a 'leak' of CSF following dural puncture. Post-LP headaches are more common in young females with a low body mass index

Typical features
  • usually develops within 24-48 hours following LP but may occur up to one week later
  • may last several days
  • worsens with upright position
  • improves with recumbent position

Factors which may contribute to headacheFactors which do not contribute to headache
  • Needle type: conventional 'cutting' needles increase the risk compared to pencil point (atraumatic) needles
    • rounded, pencil-point tip with a side opening for cerebrospinal fluid (CSF) flow
    • pencil-point design separates rather than cuts dural fibres → allows the dura to re-seal more effectively, reducing CSF leakage
  • Increased needle size
  • Direction of bevel
  • Not replacing the stylet
  • Increased number of LP attempts
  • Increased volume of CSF removed
  • Bed rest following procedure
  • Increased fluid intake post procedure
  • Opening pressure of CSF
  • Position of patient

    • Management
    • supportive initially (analgesia, rest)
    • if pain continues for more than 72 hours then specific treatment is indicated, to prevent subdural haematoma
    • treatment options include: blood patch, epidural saline and intravenous caffeine
    +PassMedicine Notes

    Headache following lumbar puncture (LP) occurs in approximately one-third of patients. The pathophysiology of is unclear but may relate to a 'leak' of CSF following dural puncture. Post-LP headaches are more common in young females with a low body mass index

    Typical features
    • usually develops within 24-48 hours following LP but may occur up to one week later
    • may last several days
    • worsens with upright position
    • improves with recumbent position
    Factors which may contribute to headache _ Factors which do not contribute to headache|
    • Needle type: conventional 'cutting' needles increase the risk compared to pencil point (atraumatic) needles
      • rounded, pencil-point tip with a side opening for cerebrospinal fluid (CSF) flow
      • pencil-point design separates rather than cuts dural fibres --> allows the dura to re-seal more effectively, reducing CSF leakage
    • Increased needle size
    • Direction of bevel
    • Not replacing the stylet
    • Increased number of LP attempts _
    • Increased volume of CSF removed
    • Bed rest following procedure
    • Increased fluid intake post procedure
    • Opening pressure of CSF
    • Position of patient|
    Management
    • supportive initially (analgesia, rest)
    • if pain continues for more than 72 hours then specific treatment is indicated, to prevent subdural haematoma
    • treatment options include: blood patch, epidural saline and intravenous caffeine


    Saved ✓

    MEDIA