Title: Factors that Decrease Post-Lumbar Puncture Headaches<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>
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                <span style="font-family: arial, helvetica, sans-serif; font-size: 14px;">Post-lumbar puncture (LP) headache, reported in up to 33% of patients, is due to a persistent CSF leak causing intracranial hypotension.</span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">A recent review by Cognat et al. looked to answer several frequently asked clinical questions:</span></span>
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                                <em><u><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Who is at decreased risk of post-LP headache?</span></span></u></em>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Infants and children have a similar prevalence compared to adults.</span></span></li>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Older patients have a lower risk, with an incidence of <5% in those over 60 years old.</span></span></li>
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                                <em><u><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Does needle choice minimize the risk of post-LP headache?</span></span></u></em>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Atraumatic non-cutting ("Whiteacre" or "Sprotte") needles have lower rates (RR 0.4, 0.34-0.47).</span></span></li>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">The use of atraumatic needles does not affect the rate of success, success on first attempt, or duration of the LP.</span></span></li>
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                                <em><u><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Does performing the LP in a specific way prevent post-LP headache?</span></span></u></em>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">LPs performed in the lateral decubitus position and at a higher intervertebral space have a lower incidence.</span></span></li>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Difficult LPs (e.g. multiple attempts, traumatic tap) do not appear to affect the rate.</span></span></li>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">The volume of CSF removed does not affect the rate.</span></span></li>
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                                <em><u><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Do any treatments after the LP reduce post-LP headache occurrence?</span></span></u></em>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Bed rest after LP does not reduce and may in fact worsen the likelihood.</span></span></li>
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                                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Fluids and caffeine do not prevent post-LP headaches.</span></span></li>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><u>Bottom Line</u>:</strong> The use of atraumatic needles is most effective in reducing the risk of post-LP headaches. These needles are easy to use and have similar rate of success as cutting needles.</span></span></p>
<fieldset><legend>References</legend>

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        <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Cognat E, Koehl B, Lilamand M, et al. Preventing post-lumbar puncture headache. <em>Ann Emerg Med</em>. 2021 May 6;S0196-0644(21)00151-7. Online ahead of print.</span></span></p>
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