Effect of Pre-Discharge Instructions on Prevention of Headache and Its Associated Symptoms among Patients Undergoing Diagnostic Lumber Puncture

Post lumber puncture headache (PLPH) has been a problem for patients, following dural puncture. Headache after lumbar puncture is a common occurrence (32%) and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilize the patient. If untreated, it can result in serious complications such as subdural haematoma and seizures, which could be fatal. The accompanying symptoms are usually nausea, vomiting and neck stiffness. Other nonspecific symptoms may occur such as ocular complaints as photophobia and diplopia, and auditory complaints like tinnitus and hyperacusis. PLPH typically manifests as a postural, frontal, front temporal, or occipital headache, worsened by ambulation and improved by assuming the lateral position, occurring within 48 hours after dural puncture. Aim : The aim of this study was to examine the effect of pre-discharge instructions on prevention of headache and its associated symptoms among patients undergoing diagnostic lumber puncture Subjects and Methods: Design: A quasi experimental design was used. Setting: This study was conducted at lumber puncture unit at hematology and hereditary department (medicine 12) affiliated to Ain Shams University Hospital. Sample: A purposive sample included 60 patients undergoing to diagnostic LP. Tools for data collection: The patient Lumber puncture interview questionnaire (Pre and Post Lumber puncture procedure), Headache Diary (Post Lumber puncture procedure throughout seven days), Headache Impact TestTM questionnaire (HIT-6TM) (Version 1.1) Post lumber puncture procedure and LP patients perception sheet. Results: The intensity of the headache among the control group was higher compared to the study group with highly statistical significant difference from day two to seven day. Also, there was no statistically significant difference regarding total knowledge regarding PLPH and associated symptoms preinstructions implementation, while there was an improvement with a highly statistically significant difference post instructions implementation. The impact of the headache on the control group higher than the study group with a highly significant difference between them regarding daily living activities. There was a significant difference between the personal characteristics and intensity of the headache between study and control group. Conclusions: The implementation of pre discharge LP instructions was effective in reducing the intensity of the PLPH and occurrence of associated symptoms. The pre discharge instructions had a positive effect in increasing the level of perceptions in the study group patients. Recommendations: It was recommended to use the Arabic Instructions in outpatients for patients undergoing lumber puncture and further studies should be carried out on a large number of subjects for evidence of results and generalization. Also, further study is recommended to evaluate the association between post lumber puncture headache and its associated factors. [Manal Salah, Neamattalla Gomaa, Hanan Shehata, Naglaa El-sayed Mahdy. Effect of Pre-Discharge Instructions on Prevention of Headache and Its Associated Symptoms among Patients Undergoing Diagnostic Lumber Puncture. J Am Sci 2013;9(1):235-250] (ISSN: 1545-1003). http://www.jofamericanscience.org. 36