Post-lumbar puncture headache

INTRODUCTION

Headache, which occurs in 10 to 30 percent of patients following lumbar puncture, is one of the most common complications of the procedure. Post-lumbar puncture headache (PLPHA; also known as post-dural puncture headache) is caused by leakage of cerebrospinal fluid from the dura with resultant traction on pain-sensitive structures.

This topic will review PLPHA. Other aspects of lumbar puncture are discussed separately. (See "Lumbar puncture: Technique; indications; contraindications; and complications in adults".)

ETIOLOGY

In 1891 Quincke introduced the lumbar puncture (LP) [1], and in 1898 Bier suffered and was the first to report PLPHA [2]. He proposed that ongoing leakage of cerebrospinal fluid (CSF) through the dural puncture site was the cause of the headache. This belief is maintained today; it is supposed that CSF leakage through the dural rent made by the LP needle exceeds the rate of CSF production, resulting in low CSF volume and pressure [3]. The reported incidence of PLPHA ranges from 10 to 30 percent [2,3].

Of note, cerebral venous thrombosis must also be considered as a possible cause of persisting headache following LP, since LP can rarely precipitate a cerebral venous thrombosis. However, unlike PLPHA, the headache related to cerebral venous thrombosis does not typically change with posture, and the severity usually increases in the acute phase of illness. (See "Etiology, clinical features, and diagnosis of cerebral venous thrombosis".)

CLINICAL FEATURES

Patients with PLPHA characteristically present with frontal or occipital headache within 6 to 72 hours of the procedure that is exacerbated in an upright position and improved in the supine position [1,4]. Associated symptoms may include nausea, vomiting, dizziness, tinnitus, neck stiffness, and visual changes [5]. Without treatment, the headache typically lasts 2 to 15 days.