Post LP Headache

25 Jun

90% headaches within 3 days.

Postural.

Keep in mind that could be intracranial hemorrhage causing repeat headache.

 

The incidence is:

  • ∼40% with a 22G needle;
  • 25% with a 25G needle,
  • 2%–12% with a 26G Quincke needle,
  • <2% with a 29G needle. (i.e. smaller is better)

Risk factors for post–lumbar puncture headache 

  • use of a large needle size (>22 gauge),
  • use of a cutting (Quincke) needle,
  • multiple attempts,
  • failure to replace the stylet when withdrawing the needle.

 

Prevention:

Smaller needles (if possible, may need at least 22G to measure pressure, obtain CSF).

Orientation – perpendicular orientation of bevel (‘split the fibers’)

 

Treatment:

Caffeine (300-500mg PO or IV daily or BID)

Blood patch

 

Submitted by J. Andrick.

 

References: Post‐dural puncture headache: pathogenesis, prevention and treatment. Turnbull DK. Brit J AnesPostgrad Med J. 2006 Nov;82(973):713-6.Post lumbar puncture headache: diagnosis and management. Ahmed SV, Jayawarna C, Jude E.; picture

 

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