Lumbar Puncture Headache

Introduction

Lumbar puncture headache is also called as;

• Spinal headache
• Spinal tap headache
• Post spinal tap or post lumbar-puncture headache etc.

Basically Lumbar puncture headache occurs as a complication to lumbar puncture or spinal tap. During this neurology test a needle is passed in the lower lumbar spine area and CSF (cerebrospinal fluid) is removed for diagnostic and/or therapeutic purposes.

What produces this headache?

During the procedure the needle will pierce through the dura matter, a layer of the meninges or brain covering, and after the needle is pulled out the puncture in the dura matter generally closes quickly and prevents any further leakage of CSF.

But in some individuals the CSF leak may continue even after the procedure is over for few to several days. As excess CSF is lost from the brain the CSF pressure decreases and when the patient assumes a sitting or standing position then an excruciating and agonizing headache may be felt, and this may be associated with nausea sometimes vomiting. There may be stiffness of the neck too. As long patient lies flat no much head ache occurs. The cause may be pulling effect on the meninges in the upright position.

This is considered as the most common complication of spinal tap procedure. The incidence is more with large bore needles. Using smaller bore needles and taking out as little amount of CSF as possible might help in preventing the post spinal headache. Also after the procedure patients are told to lay flat x about 6 hours which also may avoid this complication happening but not in all patients.

A small amount of headache is quite common with the spinal tap procedure and they get better in about a week or so. But the spinal headache that is very severe and doesn’t get better even after a week can cause lot of discomfort & concern to the patients.

If these patients have fever as well then it might indicate meningitis as a complication to the procedure. This has to be treated immediately with antibiotics. A repeat spinal tap may be required to find out the type of organism causing the meningitis.

Treatment

Patients without fever are having just severe post spinal headache. They need to lay flat as much as possible. Lot of fluids should be given especially intravenous. Some studies indicate that caffeine given by intravenous (IV) route might help significantly. If IV route not possible caffeine tablets can be given orally or patients are advised to drink coffee or tea.

Pain killers like NSAIDs (non steroidal anti-inflammatory drugs) are given and sometimes narcotic analgesics are needed.

If patient doesn’t get better in about a week or so then a procedure by name epidural blood patch is tried. With this therapeutic procedure patient’s own blood is drawn and injected into the epidural space where the spinal tap was done before. This blood will clot and close the hole and stop the CSF leak

Majority of the Lumbar Puncture Headache respond quite well with this procedure. A small percentage of patients may remain refractory to all these measures and then a surgical closure of the dural hole is required.



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