Review: longer bed rest does not prevent more postpuncture headaches than immediate mobilisation or short bed rest.

Main results 16 RCTs met the selection criteria; 1128 patients were assigned to long bed rest and 1083 patients were assigned to immediate mobilisation or short bed rest. Cervical or lumbar puncture was used for anaesthesia (5 trials), myelography (6 trials), and diagnostic reasons (5 trials). 11 trials compared bed rest with immediate mobilisation (0.5–24 h), and 5 trials compared longer bed rest (4–24 h) with short bed rest (from 0.5–8 h). In the 5 trials where reason for puncture was anaesthesia, data were not pooled because clinical heterogeneity existed; none of the trials showed superiority of longer bed rest (24 h in all 5 trials) over immediate mobilisation or short bed rest (up to 8 h) in preventing postpuncture headache. In the 6 trials where reason for puncture was myelography, longer bed rest (12 h in 1 trial and 24 h in 5 trials) was not more effective in preventing postpuncture headache than immediate mobilisation (table). In the 5 trials where puncture was done for diagnostic reasons, longer bed rest (30 min in 1 trial and 4–24 h in 4 trials) was not more effective in preventing postpuncture headache than short bed rest (immediate mobilisation in 4 trials and 30 min in 1 trial) (table).