Impact of postdural puncture headache after diagnostic lumbar puncture

Sir Lumbar puncture (LP) is an essential medical procedure for several clinical conditions. It is an invasive procedure by which physicians can provide sample of cerebrospinal fluid through a needle inserted into the lower lumbar area for diagnostic purposes (meningitis or subarachnoid hemorrhage). Injection of medications into the cerebrospinal fluid "intrathecally", particularly for spinal anesthesia which is another important use of LP. Sometimes this procedure is indicated for pain management and chemotherapy or rarely for treatment of "therapeutic lumbar puncture" to relieve increased intracranial pressure (1, 2). The most common purpose for a lumbar puncture is anesthesia setting for neuroaxial block and collecting cerebrospinal fluid in cases suspected for meningitis. This is the most reliable method for confirming meningitis or exclusion of a possible life-threatening but highly treatable condition. Examination of the CSF can be also helpful for other clinical situations such as detecting the presence of malignant cells (1, 3). Despite a relatively safe procedure, but performing LP may be associated with several adverse events including postdural (post-lumbar or post-spinal) puncture headache (PDPH) (2, 3). Physicians who frequently perform LP for diagnostic or therapeutic purpose may encounter patients at risk of developing PDPH. Although the possibility of developing PDPH is low but physicians have concerns because they are not able to accurately diagnose PDPH and get familiar with the available therapies. Occasionally, there are techniques that physicians should utilize in the performance of lumbar punctures to minimize the incidence of PDPH (1, 2, 4). Nevertheless, this is inordinately concerning the patients (1). Definition and diagnosis: PDPH is defined as any headache after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of lying down (5). The hallmark of PDPH is a constant headache that exacerbates in the upright position and improves when lying down and resolves spontaneously within five to seven days. Ninety percent of PDPHs occurs within three days of the procedure and 66% starts in the first 48 hours (4). The International Headache Society has defined PLPH as a " headache that develops within 5 days of dural puncture and resolves within 1 week spontaneously or within 48 hours after effective treatment of the spinal fluid leak " (5). The headache is usually but not always bilateral and may be characterized by frontal, occipital, or generalized pressure or throbbing occurring when the patient is upright, and diminishing or …