Lumbar-puncture headache.

The headache which sometimes develops after a lumbar puncture has a dual interest, for not only is it important in the clinical management of the patient, but also it has stimulated enquiry into the causative mechanism of headache as a whole. Post-puncture headache has characteristic features. It may appear from a few hours to a few days after the puncture, and it is made worse by jugular compression and relieved by lying down. Over a quarter of a century ago Jacobaeus and Frumerie (1923) reported low pressure of the cerebrospinal fluid in two patients with headache following lumbar puncture. Since their publication in 1923 low pressure of the cerebrospinal fluid as the cause of post-puncture headache has gained general acceptance. About a year ago Pickering (1948) published observations on seven patients on whom a second puncture was performed during a postpuncture headache. Six patients had a zero pressure, and one a pressure of 80 mm. Pickering pointed out that the converse, absence of a low pressure in patients who did not experience a post-puncture headache, had not been reported. In the present study a second puncture was performed on 43 patients regardless of the presence or absence of headache. They were consecutive admissions to the Department of Neurology at the Manchester Royal Infirmary, but patients suffering from cerebral tumour, cerebral abscess, meningitis, or sub-arachnoid hemorrhage were excluded.