Does Immediate Mobilization Increase Post Lumbar Puncture - Headache ?

OBJECTIVE: To determine if immediate mobilization after lumbar puncture (LP) increases the incidence of post lumbar puncture headache (PLPHA). BACKGROUND: PLPHA occurs commonly: the average frequency of PLPHA in patients after diagnostic LP has been reported to be about 30%. There are no convincing studies to show that bed rest after LP reduces PLPHA. The benefit of bed rest to prevent PLPHA remains controversial. If immediate mobilization does not increase the occurrence of PLPHA compared to bed rest, patients can be safely discharged as soon as the procedure is complete. This will improve utilization of resources. STUDY DESIGN: This is a prospective randomized study. Patients were recruited from the LP clinic of a large tertiary care facility. Consecutive patients seen here over a 5 month period (February through June 2001) were included in the study. The patients were randomized to bed rest or immediate mobilization post LP. The main outcome variable was the presence (or absence) of PLPHA. STATISTICAL ANALYSIS: Baseline demographic characteristics were compared in the two groups using the t-test for independent samples for quantitative variables and the chi-square test for categorical variables. The difference in the proportion of patients with post-LP headache in the two groups was compared using the chi-square test. RESULTS & DISCUSSION: We found that immediate mobilization after LP does not increase the incidence of PLPHA. There was no difference in the duration of PLPHA when it did occur. These findings suggest that the routine practice of bed rest after LP may be unnecessary.