Hypersensitivity to Substance P in the Etiology of Postlumbar Puncture Headache

Solomon, Glen D.; Clark, Jeffrey W.; DeSenanayake, Preenie; Kunkel, R.

doi:10.1111/j.1526-4610.1995.hed3501025.x

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…Patients reporting headache prior to LP and those susceptible to headaches are more likely to complain of PPH 15 . This is consistent with the work of Solomon et al who suggest that PPH may be mediated by a LP‐induced release of substance P in patients predisposed to headache as a result of a hypersensitivity to this substance 16 .…”

Section: Complications Of Lumbar Puncturesupporting

confidence: 88%

Lumbar puncture: risks and complications

Taylor

1996

Emergency Medicine

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Lumbar puncture is a procedure commonly performed in the emergency department. This paper reviews the indications, contraindications and the complications of lumbar puncture such as post‐lumbar puncture headache, traumatic tap and cerebral herniation. As well as highlighting the particular risks of lumbar puncture in different disease processes, this paper aims to provide physicians with an understanding of the procedure that will assist them in their clinical decision making. The role of computed tomography and medico‐legal aspects of lumbar puncture are also discussed.

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Section: Complications Of Lumbar Puncturesupporting

confidence: 88%

Lumbar puncture: risks and complications

Taylor

1996

Emergency Medicine

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“…Another interesting fact is that recurrent episodes of PDPH have been present only in women in our series, despite the presence of 112 men enrolled in the study. Common hypotheses for the increased susceptibility of women to PDPH are: (i) young women may be at greater risk because of increased dural fibre elasticity, which could maintain a patent dural defect better than a less elastic dura (1); and (ii) oestrogens might increase substance P receptor sensitivity (21). One may also speculate that besides the psychological and hormonal aspects (22), one factor to explain the female susceptibility to recurrent PDPH is gender difference in the brain–skull–vertebral canal morphology (23), particularly at the craniospinal junction.…”

Section: Discussionmentioning

confidence: 99%

Postdural Puncture Headache is a Risk Factor for New Postdural Puncture Headache

Amorim

Valença

2007

Cephalalgia

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The aim of this study was to determine if patients with a previous history of postdural puncture headache (PDPH) might be prone to a new episode after spinal anaesthesia. Consecutive patients (n = 258) who had had surgery under spinal anaesthesia were studied. Of 42 patients with a previous history of PDPH, eight (19.0%) developed a new PDPH episode; whereas out of 216 without a previous history of PDPH, only 15 (6.9%) presented with PDPH. Previous PDPH history indicates a higher chance of a new episode of PDPH after spinal anaesthesia. Women are more susceptible to such recurrences.

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“…12,13 The frequency is less in children younger than 13 years 14 and in both men and women older than 60 years.…”

Section: 9mentioning

confidence: 99%

“…11 The highest frequency is in the 18-to 30-year-old age group. 12,13 The frequency is less in children younger than 13 years 14 and in both men and women older than 60 years. 11 One study reports that the incidence is greater in patients with small body mass index (weight/height 2 ).…”

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confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

246

136

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Headache (HA) is a common sequel to lumbar puncture (LP), whether performed for diagnosis or anesthesia. [1][2][3][4][5][6] In their monograph summarizing the world literature through 1960, Tourtellotte et al.1 considered separately three principal patient populations: 1) patients undergoing diagnostic LPs (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA; 2) patients undergoing nonobstetric spinal anesthesia; and 3) patients undergoing obstetric spinal anesthesia. They reported several observations.1. The average frequency of post-LP HAs (PLPHA) in patients after diagnostic LP (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA, was 32%. For nonobstetric spinal anesthesia, the average frequency was 13%. For obstetric spinal anesthesia, the average frequency was 18%. 2. In reports in which patients received special measures to prevent PLPHA, the average frequencies were 6% for diagnostic LPs, 5.5% for nonobstetric spinal anesthesia, and 6.2% for obstetric spinal anesthesia. The actual frequencies in individual series ranged from 0 to 18%. 3. The frequency of PLPHA was 36% in their own series of 105 normal individuals, 30% in 317 patients with diagnostic LPs, and 2% definite and 2% probable in 100 patients undergoing spinal anesthesia (but 30 patients with HAs of other types were excluded from the latter count).In analyzing risk factors for PLPHA, they concluded that the evidence, including their own prospective series, was convincing to consider younger age and female gender as definite risk factors. They attributed the difference of PLPHAs in obstetric and nonobstetric patients undergoing spinal anesthesia at least in part to these factors. They further considered the data fairly convincing that the smaller the needle size, the lower the frequency of PLPHA, but were unable to show this in their prospective series. They commented that the great variability of HA frequency for the same needle size between authors may reduce the reliability of this observation. With regard to all other risk factors, they concluded that the evidence was inconclusive. With regard to all preventive or therapeutic measures, they commented that proponents of a particular treatment, in general, found it to be beneficial; however, some of the reports were uncontrolled and some results could not be replicated by others. Today, we would consider the latter findings a result of publication bias-if one first tried a new approach to reducing the incidence of PLPHA, one would be less likely to publish a failure than a success.They commented on the different frequency of PLPHA in patients undergoing diagnostic LP compared with those undergoing spinal anesthesia, and considered the following factors in their series: age, gender, needle size, fasting, hydration, premedication and postoperative medication, minimal amount of trauma to the meninge...

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Hypersensitivity to Substance P in the Etiology of Postlumbar Puncture Headache

Abstract: Postlumbar puncture headache may be mediated by the release of substance P triggered by lumbar puncture, in patients predisposed to headache by a hypersensitivity to substance P. Hypersensitivity to substance P may also represent a mechanism for headache pain in other headache disorders.

Cited by 11 publications

References 6 publications

Lumbar puncture: risks and complications

Lumbar puncture: risks and complications

Postdural Puncture Headache is a Risk Factor for New Postdural Puncture Headache

Assessment: Prevention of post–lumbar puncture headaches

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