UMEM Educational Pearls

Category: Neurology

Title: Factors that Decrease Post-Lumbar Puncture Headaches

Keywords: Lumbar puncture, LP, post-dural, headache, intracranial hypotension (PubMed Search)

Posted: 5/12/2021 by WanTsu Wendy Chang, MD (Updated: 10/21/2021)
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  • Post-lumbar puncture (LP) headache, reported in up to 33% of patients, is due to a persistent CSF leak causing intracranial hypotension.
  • A recent review by Cognat et al. looked to answer several frequently asked clinical questions:
    • Who is at decreased risk of post-LP headache?
      • Infants and children have a similar prevalence compared to adults.
      • Older patients have a lower risk, with an incidence of <5% in those over 60 years old.
    • Does needle choice minimize the risk of post-LP headache?
      • Atraumatic non-cutting ("Whiteacre" or "Sprotte") needles have lower rates (RR 0.4, 0.34-0.47).
      • The use of atraumatic needles does not affect the rate of success, success on first attempt, or duration of the LP.
    • Does performing the LP in a specific way prevent post-LP headache?
      • LPs performed in the lateral decubitus position and at a higher intervertebral space have a lower incidence.
      • Difficult LPs (e.g. multiple attempts, traumatic tap) do not appear to affect the rate.
      • The volume of CSF removed does not affect the rate.
    • Do any treatments after the LP reduce post-LP headache occurrence?
      • Bed rest after LP does not reduce and may in fact worsen the likelihood.
      • Fluids and caffeine do not prevent post-LP headaches.

Bottom Line: 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.

References

Cognat E, Koehl B, Lilamand M, et al. Preventing post-lumbar puncture headache. Ann Emerg Med. 2021 May 6;S0196-0644(21)00151-7. Online ahead of print.

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