Post-lumbar puncture headache: Difference between revisions
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==Background== | ==Background== | ||
*10-36% of patients develop headache within 24- | *Also known as a "post-dural puncture headache" | ||
* | *10-36% of patients develop headache within 24-48 hours post-[[LP]] | ||
*Due to persistent CSF leak | |||
*A 2018 meta analysis showed atraumatic needles had a lower incidence of post-LP headache and need for blood patch when compared to sharp needles<ref>Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review And Meta-Analysis Nath, S., et al, Lancet 391(10126):1197, March 24, 2018</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 13: | Line 15: | ||
==Management== | ==Management== | ||
*Simple analgesics | *Simple [[analgesia|analgesics]] | ||
*IV fluids | *[[IV fluids]] | ||
*IV caffeine<ref>Yücel A, Ozyalçin S, Talu GK, et al. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24:51.</ref> | *PO [[caffeine]]<ref>Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990 Feb;70(2):181-4. doi: 10.1213/00000539-199002000-00009. PMID: 2405733.</ref> | ||
**300mg PO x 1 | |||
*IV [[caffeine]]<ref>Yücel A, Ozyalçin S, Talu GK, et al. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24:51.</ref> | |||
**500mg (in 1 L of NS) over 1 hour, followed by 1 L of NS x 1 hour | **500mg (in 1 L of NS) over 1 hour, followed by 1 L of NS x 1 hour | ||
**Give second dose in 4 hours if pain persists | **Give second dose in 4 hours if pain persists | ||
| Line 23: | Line 27: | ||
*Minimize risk by: | *Minimize risk by: | ||
**Orienting needle bevel parallel to longitudinal fibers of dura | **Orienting needle bevel parallel to longitudinal fibers of dura | ||
**Using smaller-bore needles | **Using smaller-bore needles (22 gauge or smaller) | ||
**Using atraumatic needles | **Using atraumatic needles | ||
*Recumbency and bedrest NOT effective | **Stylet replacement before needle removal | ||
*Recumbency and bedrest NOT effective<ref>Arevalo-Rodriguez I, Ciapponi A, Roque I Figuls M, et al. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2016;3:CD009199.</ref> | |||
==See Also== | |||
*[[Lumbar Puncture]] | |||
==References== | ==References== | ||
Latest revision as of 23:21, 7 June 2023
Background
- Also known as a "post-dural puncture headache"
- 10-36% of patients develop headache within 24-48 hours post-LP
- Due to persistent CSF leak
- A 2018 meta analysis showed atraumatic needles had a lower incidence of post-LP headache and need for blood patch when compared to sharp needles[1]
Clinical Features
- Worsening with upright position and relief with recumbency
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- Normally by history
Management
- Simple analgesics
- IV fluids
- PO caffeine[2]
- 300mg PO x 1
- IV caffeine[3]
- 500mg (in 1 L of NS) over 1 hour, followed by 1 L of NS x 1 hour
- Give second dose in 4 hours if pain persists
- Blood patch if above fails
Prevention
- Minimize risk by:
- Orienting needle bevel parallel to longitudinal fibers of dura
- Using smaller-bore needles (22 gauge or smaller)
- Using atraumatic needles
- Stylet replacement before needle removal
- Recumbency and bedrest NOT effective[4]
See Also
References
- ↑ Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review And Meta-Analysis Nath, S., et al, Lancet 391(10126):1197, March 24, 2018
- ↑ Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990 Feb;70(2):181-4. doi: 10.1213/00000539-199002000-00009. PMID: 2405733.
- ↑ Yücel A, Ozyalçin S, Talu GK, et al. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24:51.
- ↑ Arevalo-Rodriguez I, Ciapponi A, Roque I Figuls M, et al. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2016;3:CD009199.