Preventing Post-Lumbar Puncture Headache.

Emmanuel Cognat, Berengère Koehl, Matthieu Lilamand, Stéphane Goutagny, Anissa Belbachir, Louise de Charentenay, Tamazoust Guiddir, Paul Zetlaoui, Caroline Roos, Claire Paquet

Journal: Annals of emergency medicine 2021;78(3):443-450

PMID: 33966935

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Abstract

Post-lumbar puncture headache is the main adverse event from lumbar puncture and occurs in 3.5% to 33% of patients, causing functional and socio-professional disability. We searched the post-lumbar puncture headache literature and, based on this review and personal expertise, identified and addressed 19 frequently asked questions regarding post-lumbar puncture headache risk factors and prevention. Among the nonmodifiable factors, older age is associated with a lower incidence of post-lumbar puncture headache, while female sex, lower body mass index, and history of headache might be associated with increased risk. The use of atraumatic, noncutting needles is the most effective intervention for post-lumbar puncture headache prevention. These needles are not more difficult to use than cutting needles. Other commonly recommended measures (eg, fluid supplementation, caffeine) appear unhelpful, and some (eg, bed rest) may worsen post-lumbar puncture headache.

Address: Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France. Electronic address: [email protected].; Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France.; Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France; Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France; Département de Gériatrie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Sites Bichat et Bretonneau, Paris, France.; Service de Neurochirurgie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Beaujon, Clichy, France.; Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France.; Service de Pédiatrie, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France.; Service d'Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France.; Centre d'Urgence des Céphalées, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris, France.; Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France.

DOI: 10.1016/j.annemergmed.2021.02.019

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MeSH Terms: Age Factors, Body Mass Index, Female, Humans, Male, Needles, Post-Dural Puncture Headache, Risk Factors, Sex Factors, Spinal Puncture