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. 500mg (in 1 L of NS) over 1 hour, followed by 1 L of NS x 1 hour
   2. 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