Lumbar puncture headache in relation to age of patient and rest after puncture.

Examination of the cerebrospinal fluid is an essential step in the diagnosis of late syphilis and is also necessary before any treated case of primary or secondary syphilis can be discharged as cured. The problem of lumbar puncture headache is therefore one of importance in all venereal disease clinics and the adoption of any method of reducing its incidence must be considered. Various procedures for the prevention of headache have been advocated, including the intravenous injection of saline immediately after puncture (Baar, 1920), the intramuscular injection of pituitary extract (Alpers, 1925), the use of small gauge needles (Greene, 1950) or double needles (Gallagher and Campbell, 1954), and even the plugging of the puncture hole with a length of catgut (Nelson, 1930). Some methods are not practical for use in an outpatient clinic and others are not always successful. Dattner (1944), in a summary of some of these methods, concludes: " the variety of measures recommended makes their value extremely doubtful". Rest.-On the question of rest after puncture, opinions are divided. Series of cases have been reported to show that an immediate return to full activity results in a lower incidence of post puncture headache and Dattner (1944) quotes the suggestion of the Association of Syphilis Clinics that " there is abundant evidence to prove that rest immediately following the puncture has no prophylactic value ". However, on the question of allowing activity after lumbar puncture, Stokes, Beerman, and Ingraham (1944) say " not yet recommended ". Many venereologists still suggest some form of rest or modified activity after puncture. This may be done solely because the onset of a severe lumbar puncture headache can be a very frightening experience, even in a forewarned patient, and is even worse if it develops when the patient is away from home. Such an occurrence tends to have an adverse effect on future attendance for treatment and certainly on the patient's reaction to any suggestion for further puncture. In most clinics the facilities