Post-epidural headache Flashcards
In what proportion of patients undergoing lumbar puncture does headache occur?
1/3
What is thought to be the pathophysiology of post-lumbar puncture headache?
Pathophysiology unclear, may relate to ‘leak’ of CSF following dural puncture
In what group of patients is post-lumbar puncture headache most common?
young females with low body mass index
What is the typical time frame of a post-lumbar puncture headache?
Develops within 24-48 following LP but may occur up to one week later
May last several days
What exacerbates/ improves post-lumbar puncture headache?
Worse when upright, improves in recumbent position
What are 4 factors that increase the likelihood of a post-lumbar puncture headache?
- Increased needle size
- Direction of bevel
- Not replacing the stylet
- Increased number of LP attempts
What are 5 features that reduce likelihood of post-lumbar puncture headache?
- Increased volume of CSF
- Bed rest following procedure
- Increased fluid intake post-procedure
- Opening pressure of CSF
- Position of patient
What is the initial treatment for post-lumbar puncture headache and what should be done if it does not improve?
- Supportive initially: analgesia, rest
- If continues for >72 hours: specific treatment to prevent subdural haematoma
- blood patch, epidural saline, IV caffeine
When should specific treatment be pursued for post-lumbar puncture headache and why?
If pain continues for logner than 72 hours, to prevent subdural haematoma
What are 3 treatment options for a post-lumbar puncture headache lasting >72 hours?
- Blood patch
- Epidural saline
- IV caffeine
