Post-lumbar puncture headache
- Christina Sun-Edelstein, MD
Christina Sun-Edelstein, MD
- Department of Clinical Neurosciences
- St. Vincent's Hospital
- Christine L Lay, MD, FRCPC
Christine L Lay, MD, FRCPC
- Associate Professor
- Women's College Hospital
- Section Editor
- Jerry W Swanson, MD, MHPE
Jerry W Swanson, MD, MHPE
- Section Editor — Headache
- Professor of Neurology
- Mayo Clinic College of Medicine
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. The technique of lumbar puncture is discussed separately. (See "Lumbar puncture: Technique, indications, contraindications, and complications in adults".)
Other conditions related to altered cerebrospinal fluid pressure are reviewed elsewhere. (See "Cerebrospinal fluid: Physiology and utility of an examination in disease states" and "Spontaneous intracranial hypotension: Pathophysiology, clinical features, and diagnosis" and "Idiopathic intracranial hypertension (pseudotumor cerebri): Epidemiology and pathogenesis" and "Idiopathic intracranial hypertension (pseudotumor cerebri): Clinical features and diagnosis".)
In 1891 Quincke introduced the lumbar puncture (LP) , and in 1898 Bier suffered from and was the first to report PLPHA . 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 . 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".)
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