Post-dural-puncture headache: Characteristics, management, and prevention

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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“…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: 98%

“…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 ).…”

mentioning

confidence: 98%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

246

136

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“…The primary disease in the study population was acute lymphoblastic leukaemia (Table II). Other diseases among the paediatric population included lymphoma (8), Ewing's sarcoma (4), neuroblastoma (2), idiopathic t_hrombocytopenia (2) and aplasfic anaemia (1).…”

Section: Methodsmentioning

confidence: 99%

Postdural puncture headache in paediatric oncology patients

et al. 1998

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Postdural puncture headache in paediatric oncology patientsPurpose: Previous studies have not determined the correlation between dural puncture and postural headache in paediatric patients. Furthermore, no studies have evaluated the correlation between atypical headache and dural puncture iri the paediatric population. Therefore, we prospectively analyzed the incidence of typical postdural puncture headache (PDPHA) and atypical headache in paediatric ontology patients following dural puncture. Methods: The study population consisted of 66 paediatric patients undergoing 128 consecutive procedures, including 99 lumbar punctures and 29 bone marrow aspirations without concomitant lumbar puncture. Patients were prospectively randomized into four groups: Group I, preteens (< 13 yr) undergoing lumbar puncture, Group II, adolescents (13-21 yr) undergoing lumbar puncture, Group III, preteens undergoing bone marrow aspiration, and Group IV, adolescents undergoing bone marrow aspiration. The presence and description of headache was documented immediately after dural puncture or bone marrow aspiration, and on post-procedure days # I, 3 and 5 by personnel blinded to the type of procedure. Results: There was an increase in the incidence of headache (9. 1%) after lumbar puncture in patients < 21 yr relative to patients undergoing bone marrow aspiration (P < 0.05). No difference was found between the incidence of typical PDPHA after dural puncture in preteens and adolescents. There was also no difference in the incidence of atypical headache after dural puncture or after bone marrow aspiration among preteens and adolescents. Conclusions: Paediatric patients experience an increased incidence of typical postdural puncture headache after dural puncture compared with age-matched patients undergoing bone marrow aspiration only. Atypical headache is relatively common in the paediatric population after dural puncture or bone marrow aspiration.Objecdf: Les &udes ant&ieures n'ont pas &abli de correlation entre la ponction durale et ta c~phal~e posturale chez les patients pEdiatriques. En outre, aucune Etude de cette population n'a EvaluE le lien entre la cEphalEe atypique et la ponction durale. Par consequent, ~ la suite d'une ponction durale, nous avons analys~ de fa~on prospective I'incidence d'une cEphalEe de ponction postdurale (CPPD) typique et atypique chez des patients d'oncologie pEdiatrique. M~thode : La population de I'Etude 6tait constituEe de 66 patients de p6diatrie subissant 128 examens cons&utifs, comprenant 99 ponctions Iombaires et 29 ponctions m6dullaires sans ponction Iombaire concomitante. Les patients ont ~t~ r~partis au hasard en quatre groupes de fa~on prospective: Groupe I de pr6-adolescents (< 13 ans) subissant une ponction Iombaire; Groupe II d'adolescents (13-21 ans) subissant une ponction lombaire; Groupe III de prE-adolescents inscrits pour une ponction mEdullaire et Groupe IV d'adolescents pour une ponction mEdullaire. La presence de cEphalEe a EtE vErifiEe et dEcrite immEdiatement aprEs la ponction durale ...

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“…90% of headache will occur within 3 days of the procedure [40] & 66% start within the first 48 hour [41]. It can be delayed for upto 12days.…”

Section: Clinical Symptoms 611 Headachementioning

confidence: 99%

Perioperative Management of post dural puncture headache

Shaikh¹,

Ramesh²

2015

Int J of Biomed & Adv Res

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Post dural puncture headache (PDPH) is a common complication of interventional neuraxial procedures. It carries a considerable morbidity with symptoms lasting for several days, sometimes severe enough to immobilise the patient. If left untreated it can result in serious complication which may be fatal. It is therefore important that the doctors should aware of the methods available for reducing the incidence of PDPH. This article reviews the scientific literature involved in the management of PDPH including the epidural blood patch.

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Post-dural-puncture headache: Characteristics, management, and prevention

Cited by 91 publications

References 39 publications

Assessment: Prevention of post–lumbar puncture headaches

Assessment: Prevention of post–lumbar puncture headaches

Postdural puncture headache in paediatric oncology patients

Perioperative Management of post dural puncture headache

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