Post-lumbar puncture headache

Background

  • 10-36% of pts develop HA within 24-48hrs post-LP

Clinical Features

  1. Worsening with upright position and relief with recumbency

Treatment

  1. Simple analgesics
  2. IV fluids
  3. IV caffeine
    1. 500 mg (diluted in 1 L of NS) over one hour[1], followed by 1 L of NS x 1 hour
    2. Can give second dose in 4 hours if pain persists
  4. Blood patch if above fails

Prevention

  1. Minimize risk by:
    1. Orienting needle bevel parallel to longitudinal fibers of dura
    2. Using smaller-bore needles
    3. Using atraumatic needles
  2. Recumbency, bedrest not effective

Source

Tintinalli

  1. ↑ 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.
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