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JAMA Neurol. 2015 Mar;72(3):325-32. doi: 10.1001/jamaneurol.2014.3974.

Factors associated with the onset and persistence of post-lumbar puncture headache.

Author information

1
University of Puerto Rico School of Medicine, San Juan2Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, Missouri.
2
Department of Neurology, Washington University School of Medicine, St Louis, Missouri4Dominantly Inherited Alzheimer Network Clinical Core, Washington University School of Medicine, St Louis, Missouri.
3
Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
4
Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
5
Department of Neurology, Columbia University Medical Center, New York, New York.
6
Mary S. Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles.
7
Department of Neurology, Washington University School of Medicine, St Louis, Missouri5Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
8
Department of Neurology, Ludwig-Maximilians Universität Munich, Munich, Germany.
9
Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
10
Neuroscience Research Australia, University of New South Wales, Sydney.
11
The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.
12
School of Life and Medical Sciences,University College London, London, England.
13
Indiana Alzheimer Disease Center, Indiana University, Indianapolis.
14
Department of Radiology, Mayo Clinic, Jacksonville, Florida.
15
Memory and Aging Program, Butler Hospital, Brown Medical School, Providence, Rhode Island.

Abstract

IMPORTANCE:

This study assesses factors associated with the most common adverse event following lumbar puncture.

OBJECTIVE:

To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH).

DESIGN, SETTING, AND PARTICIPANTS:

We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects.

MAIN OUTCOMES AND MEASURES:

We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected.

RESULTS:

The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles.

CONCLUSIONS AND RELEVANCE:

Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.

PMID:
25622095
PMCID:
PMC4364538
DOI:
10.1001/jamaneurol.2014.3974
[Indexed for MEDLINE]
Free PMC Article

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