Post-lumbar puncture headache

Background

  • 10-36% of patients develop headache within 24-48hrs post-LP
  • Also known as "Postdural Puncture Headaches"

Clinical Features

  • Worsening with upright position and relief with recumbency

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Evaluation

  • Normally by history

Management

  • Simple analgesics
  • IV fluids
  • IV caffeine[1]
    • 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
    • Using atraumatic needles
  • Recumbency and bedrest NOT effective

References

  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.