Post-lumbar puncture headache
(Redirected from Postdural Puncture Headaches)
Background
- 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
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- Normally by history
Management
- 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
Prevention
- 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
References
- ↑ Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review And Meta-Analysis Nath, S., et al, Lancet 391(10126):1197, March 24, 2018
- ↑ 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.
- ↑ 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.
- ↑ 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.