Post-lumbar puncture headache


  • 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






Aseptic Meningitis


  • Normally by history


  • 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


  • 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


  1. Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review And Meta-Analysis Nath, S., et al, Lancet 391(10126):1197, March 24, 2018
  2. 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.
  3. 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.
  4. 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.