It should be considered as a safe alternative to an epidural blood patch for the treatment of post lumbar puncture headaches. Treatment for post lumbar puncture headaches american. Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches. Post dural puncture headache pdph is the most prevalent complication after lumbar puncture lp, with reported frequency varying from 6% to 36% of patients. Jan 02, 2006 headache after lumbar puncture is an uncommon complication. Diagnosis of post dural puncture headache the post dural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. Jcm free fulltext postlumbar puncture headachedoes.
We systematically collected and analyzed many items. Feb 03, 2020 the headache may be mild to severe and may get worse when you sit or stand. Standardizing management of postdural puncture headache in. Majd sa, pourfarzam s, ghasemi h, yarmohammadi me, davati a, jaberian m. Caffeine sodium benzoate is a simple treatment of postlumbarpuncture headaches.
This headache, called postdural puncture pdph, or lowpressure headache. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Headache after lumbar puncture is defined as bilateral headaches that develop within 7 days after the procedure and disappear within 14 days, and has a definite relationship to the patients position. Postdural puncture headache pdph is a potential expected complication of a lumbar puncture, with symptoms related to traction on painsensitive structures from low cerebrospinal fluid csf pressure intracranial hypotension following a leak of csf at the puncture site. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent position. You may develop a headache after a lumbar puncture that begins several hours or up to 2 days after the procedure. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal andor occipital region, worsened in the upright po.
Almost half of the population who have undergone lumbar puncture spinal tap and spinal anesthesia procedures suffer from a spinal headache or postlumbar puncture headaches after that particular procedure. Intravenous theophylline rapidly decreases postlumbar. Caffeine may be used to treat a post procedure headache. Pdf evaluation of pre lumbar puncture position on post.
The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Standardizing management of postdural puncture headache. To ascertain the frequency and risk factors for post lumbar puncture headache, we studied all adults who had an ambulatory lumbar puncture lp in a 1year period. Aug 23, 2005 a medline search was conducted by one of the authors in june 2004, using the terms post lumbar puncture headache and postdural puncture headache.
You may develop a headache during the first few hours after your lp, which may last up to several days. Caffeine sodium benzoate is a simple treatment of post lumbar puncture headaches. Post dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. If you are going to measure opening pressure, you must position patient in left lateral decubitus. The most common adverse event associated with lp is postdural puncture headache pdph, which can be incapacitating and cause significant morbidity. Jun 29, 2018 spinal headaches or post lumbar puncture headaches occur when the spinal fluid leaks through the puncture site in the membrane surrounding the spinal cord. The incidence of post dural puncture headache pdph after lumbar puncture lp can be reduced from 36% to 09% by use of an atraumatic needle size 24 gauge g0. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. The headache may be mild to severe and may get worse when you sit or stand. Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilise the patient. Oct 23, 2015 lumbar puncture lp can confirm or exclude meningitis.
Dural puncture is a commonly performed invasive pro cedure for various indications like diagnostic lumbar puncture, spinal anaesthesia, myelography and. A literature search conducted by one of the authors r. Headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid csf leakage through the dural puncture. The aim of this study was to highlight the brief initial time for a remarkable decrease of plph pain levels after the. Post lumbar puncture headache low pressure headache post lumbar puncture low pressure headache occurs in 10% to 30% of patients within 1 to 3 days and can last 2 to 7 days. The prevalence of pdph is higher in pregnant women, and extensive data are. Postdural puncture headache pdph is a common complication after lumbar puncture. Immediate mobilization was compared with bed rest for 6 h 3 h prone followed by 3 h supine posture. This may occasionally be severe, but usually settles on its own over a few days. If untreated, it can result in serious complications such as subdural haematoma and seizures, which could be fatal. Needle size has no relation to the incidence of headaches after lumbar puncture.
Csf culture is the gold standard in the diagnosis of bacterial meningitis. As csf pressure decreases, such as with a leak, blood vessels in the brain will dilate get bigger to get more. Occasionally patients may require another procedure very similar to the lumbar puncture to fix the headache. Articles linked electronically to the original assessment 1 were also considered.
Associated symptoms include stiff neck, hearing loss, tinnitus, photophobia and nausea. The headache may range from mild to severe and may get worse when you sit or stand. Lumbar puncture aftercare instructions what you need to know. For patients who have previously undergone lumbar surgery. History of headachethe history of severe headache, which begins 2 to 3 hours after back surgery, spinal anesthesia or epidural procedure suggests possible cause of headache could be dural puncture or laceration. We aimed to check whether hydration before puncture influences the incidence of postlumbar puncture headache plph and affects cerebral blood flow. This headache, called post dural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. A more recent study showed that the incidence of pdph after dural. There is no evidence that any duration of bed rest after lumbar puncture has a role in preventing headache. If untreated, it can result in serious complications such as subdural haematoma and seizures, which. Importance this study assesses factors associated with the most common adverse event following lumbar puncture objective to identify factors associated with the risk, onset, and persistence of postdural puncture headache pdph design, setting, and participants we performed univariate and multivariable analyses of 338 lumbar punctures in the dominantly inherited alzheimer network.
Quaynor and colleagues 14 had quoted an incidence of 4. Spinal headache or postlumbar puncture headachecauses. The following may help ease a postlumbar puncture headache. Lumbar puncture 2 pants or bottoms and underwear can be kept on as long as the waist band can be lowered andor folded down.
Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. Similarly, history of severe headache following work or auto accident resulting in blunt or penetrating back injury suggest possible dural injury. Headache is not an uncommon complaint during the postpartum period. Lumbar puncture aftercare instructions what you need. In addition to significant head pain, the headache may be accompanied by nausea, vomiting and dizziness and can last from a few hours to a week or more. Ninetynine patients enrolled for puncture were assigned to a group with n 40 or without hydration n 59. Headache after lumbar puncture the following factors do not influence the incidence of headache after lumbar puncture. Risk factors for post lumbar puncture headache sciencedirect. It is often relieved by caffeine, aspirin or tylenol, and drinking plenty of fluids. When managing therapy for the postlumbar puncture headaches plphs, an efficacious, fastacting, practical and safe method is preferred. The new england journal of medicine n engl j med 355. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement.
Patients filled out a questionnaire detailing their headache experience on the day of, and the 6 days following, lp. According to the headache classification committee of the international headache society, 5 headache after lumbar puncture is defined as bilateral headaches that develop within 7 days after an lumbar puncture and disappears within 14 days. It is not clear whether drs turnbull and shepherd have included patients with post. The following may help ease a post lumbar puncture headache. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter. Pdf lumbar puncture is a frequently performed procedure in medical emergencies and anaesthesia. The onset is usually within the first three days of the dural puncture 90% of pa tients and 66% starts in the first 48 hours 1 11 12. Those who did not return the questionnaire were telephoned. The etiology and pathogenesis of post lp headache are unknown.
This is an analytic, interventional, cross sectional study to evaluate the risk factors of postdural postlumbar puncture headache pdph and the validity of the diagnostic criteria for pdph from the ichd ii. Cover the puncture site with a bandaid or occlusive dressing eg tegaderm bedrest following lumbar puncture is of no benefit in preventing headache in children. Factors contributing to the postlumbar puncture headache. The risk of developing an infection from the procedure is rare and significantly reduced by the doctor cleaning your back carefully before. Lumbar puncture spinal tap discharge instructions 2 medications you can take your normal prescription medicines as your doctor has instructed you to do. Review article post dural puncture headache semantic scholar. Epidural blood patching for preventing and treating postdural puncture headache. Appropriate literature was identified by medline searches back to 1966 using the following key words and phrases. The patient reported complete resolution of symptoms and no recurrence of headache. Examples of these conditions include meningitis and subarachnoid.
Drinks such as coffee, tea, or some soft drinks have caffeine. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent. Influence of the preoperative time in upright sitting position and the needle type on the incidence of post dural puncture headache pdph in patients receiving a spinal saddle block for anorectal surgery. Lumbar puncture lp, also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid csf for diagnostic testing. Headache is a common complication after diagnostic lumbar puncture dlp. To ascertain the frequency and risk factors for postlumbar puncture headache, we studied all adults who had an ambulatory lumbar puncture lp in a 1year period. It remits spontaneously within 2 weeks, or after sealing of the leak with autologous epidural lumbar patch. The amount of fluid drained off during a lumbar puncture varies there doesnt seem to be a link between the amount of fluid drained and the incidence of developing low. If you are not taking a prescription pain medicine, ask your doctor if you can take an overthecounter medicine for your pain. Post dural puncture headache pdph is a common complication after lumbar puncture. Spinal headaches, also known as postlumbar puncture headaches, are those headaches which a person suffers after undergoing a lumbar puncture spinal tap and spinal anesthesia.
If you develop a headache that persists more than 24 hours, in particular one that is worse on sitting or standing, and better when lying down, then call the doctor or study coordinator at the clinic. Pdph continues to be a common morbidity despite several innovations in equipment and techniques used for spinal subarachnoid and epidural extradural. If you develop a headache that persists more than 24 hours, in particular one that is worse on sitting or standing, and better when lying down, then call. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Lumbar puncture, also called an lp or spinal tap, is a procedure where a needle is.
Incidence and management of postdural puncture headache. The position after lumbar puncture, needle type and size, and volume of the extracted cerebrospinal fluid csf have been evaluated as. Postdural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. Open access full text article postdural puncture headache. Postdural puncture headache pdph statpearls ncbi bookshelf. Postdural puncture headache pdph is the most prevalent complication after lumbar puncture lp, with reported frequency varying from 6% to 36% of patients. This happens when the amount of csf and the csf pressure are decreased, such as with a csf leak. Lumbar puncture ed patient factsheet nsw agency for. The volume of the spinal fluid removed is not a risk factor for headache after lumbar puncture.
Diagnosis of postdural puncture headache the postdural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. It is usually accompanied by neck stiffness andor subjective hearing symptoms. In this singleblind, randomized study of postlumbarpuncture headache pph in 300 neurologic inpatients the significance of body posture after lumbar puncture lp was evaluated. Needle type and the risk of post lumbar puncture headache in the outpatient neurology clinic. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. The etiology and pathogenesis of postlp headache are unknown. Give pt gown to wear, leave open in back, and offer a blanket positioning. It is exacerbated by movement and sitting or standing. Lumbar puncture lp can confirm or exclude meningitis. Lumbar puncture is a frequently performed procedure in medical emergencies and anaesthesia. Pdph typically presents with headache in frontaloccipital region which is postural in nature, that is worse on standing and better when lying down. The headache may be more severe when you are sitting or standing, and. In immunocompromised patients, csf white cell counts are often low.
Factors associated with the onset and persistence of postlumbar puncture headache. Parent information sheet print version pdf parent information sheet html version. More than 90% of cases of acute bacterial meningitis present with a csf white cell count of more than 100 cells per. Evaluation of pre lumbar puncture position on post lumbar puncture headache.
Drink more liquid than usual after your lumbar puncture. Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. About one third of patients develop headaches after lumbar puncture, although the incidence may be higher, as minor symptoms may not be reported. Lumbar puncture hematoma or painful lump around the site. The most common complication of lumbar puncture lp occurring in over thirty percent of patients is headache. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. High or total spinal block is discussed separately. It should be considered as a safe alternative to an epidural blood patch for the treatment of postlumbarpuncture headaches.
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