Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention.

Clark, Jeffrey W.; Solomon, Glen D.; Senanayake, P.; Gallagher, Clare

doi:10.1136/jnnp.60.6.681

Cited by 60 publications

(38 citation statements)

References 19 publications

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“…On the other hand, hypersensitivity to substance P and the Monro-Kellie doctrine, which suggests that compensatory intracranial vasodilatation is induced by CSF leakage, have recently been recognized as viable hypotheses regarding the cause of PDPH [1,21]. Considering these new hypotheses, it is not surprising that some of the patients in this study without definite CSF leakage on MRM images complained of PDPH.…”

Section: Discussionmentioning

confidence: 76%

Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

et al. 2013

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BackgroundPost-dural puncture headache (PDPH) due to excessive cerebrospinal fluid (CSF) leakage is a well-known complication of lumbar puncture. Although various factors, especially the type of spinal needle, have been demonstrated to be associated with PDPH, the clinical implications of CSF leakage detected on magnetic resonance myelography (MRM) images remain unclear. The objective of this case–control study was to evaluate the association between radiologically visualized CSF leakage and PDPH.MethodsClinical data including patients’ age and gender, types of spinal needle, duration of bed rest, interval between lumbar puncture procedures and MRM studies, and incidence of PDPH were compared between patients who were radiologically-positive and -negative for CSF leakage.ResultsOf the 22 patients with definite CSF leakage on MRM images, most were asymptomatic (86%, 19/22). The remaining three patients, who were suffering from PDPH, only complained of headaches and were treated conservatively. In a review of patients’ clinical data, there were no significant differences in any parameter including the incidence of PDPH between the 22 patients who were radiologically-positive for CSF leakage and the 31 radiologically-negative patients.ConclusionThe significance of radiologically visualized CSF leakage should not be overestimated, as most such incidents are not associated with PDPH and do not require any treatment.

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Section: Discussionmentioning

confidence: 76%

Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

et al. 2013

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“…Other proposed mechanisms for the pain of PDPH include a resultant dilatation of the cerebral blood vessels as a compensatory mechanism to restore intracranial volume, which may further exacerbate the symptoms (6). Clark also found that patients with low CSF levels of the neurotransmitter substance P, which is released with dural puncture, were three times more likely to have PDPHs than those with higher levels (15). Hypersensitivity to substance P with upregulation of receptors is thought to be a causative factor in post-dural puncture as well as other types of headache.…”

Section: Pathophysiologymentioning

confidence: 96%

“…Race does not seem to be a factor in development of PDPH (25). A history of chronic or recurrent headache has been found in nearly 60% of those with PDPH (15). Previous history of PDPH is also a risk factor for development of future headaches (43).…”

Section: Demographic and Other Risk Factorsmentioning

confidence: 97%

Lumbar Puncture and Post-Dural Puncture Headaches: Implications for the Emergency Physician

Frank¹

2008

The Journal of Emergency Medicine

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“…7,15,16 The HAs are more severe and last longer than in those without a previous or current HA. 7,16 Patients with a history of PLPHA are also at increased risk. 17 The following technical factors were identified: 1.…”

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confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

244

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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Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention.

Cited by 60 publications

References 19 publications

Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

Lumbar Puncture and Post-Dural Puncture Headaches: Implications for the Emergency Physician

Assessment: Prevention of post–lumbar puncture headaches

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