Post–Lumbar Puncture Headache

Hospital Physician June 2007 51 Lumbar puncture is a common procedure performed for diagnostic, anesthetic, and obstetric purposes; however, up to one third of patients may experience headache after the procedure.1,2 In 1898, Bier was the first to report on post–lumbar puncture headache (PLPH) after he and his associates underwent lumbar puncture themselves and experienced headaches first-hand. Bier postulated that PLPH was caused by leakage of cerebrospinal fluid (CSF) through the puncture in the dura mater caused by the needle.3 A recent report from the American Academy of Neurology estimated that PLPH occurs in 13% to 32% of all patients who undergo lumbar puncture.4 Risk factors for PLPH include young age (18–32 yr), female gender (occurs nearly 2.5 times more often in women), history of previous PLPH, low body mass index, and type and size of the needle used for performing the procedure.2 Physicians should be aware of the methods for performing lumbar puncture that have been shown to minimize the occurrence of PLPH and should be able to treat this complication appropriately when it does occur. Although PLPH can resolve on its own, supportive measures such as analgesics and antiemetics are often warranted; if the headache does not respond to these measures, more invasive procedures such as epidural blood patch (EBP) or epidural saline injection may be used. This article reviews methods that have been shown to reduce the frequency of PLPH and discusses therapeutic options for patients with PLPH.