Risks for Post-Dural Puncture Headaches after Lumbar Puncture

by Joseph Esherick, M.D., FAAFP, FHM

Diagnostic lumbar punctures aid in the diagnosis of infections and diseases of the central nervous system. Life-threatening events from lumbar punctures are rare, but post–lumbar (dural) puncture headaches (PDPH) occur in 1% to 36% of patients, depending on the needle type and factors that may lower cerebrospinal fluid (CSF) pressure. To assess factors associated with common adverse events following a lumbar puncture — immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch — researchers retrospectively assessed lumbar punctures performed in 338 patients from the Dominantly Inherited Alzheimer Network.

The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 patients with PDPH receiving therapeutic blood patch (4.4%). Greater volume of CSF collected (above 30 mL) was associated with increased risk for immediate postprocedural headache. By contrast, low CSF collection volume (below 17 mL) increased the risk for headache at follow-up and need for blood patch compared with 17 to 30 mL (odds ratios, 3.07 and 5.59, respectively). Patients' being in a seated position during the procedure showed a trend to increased frequency of headaches both immediately and 24 hours after puncture.

Reference:

Monserrate AE et al. Factors associated with the onset and persistence of post–lumbar puncture headache. JAMA Neurol 2015 Mar; 72:325.