Abstract
Objective
Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar
punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture
site. We conducted a prospective study to determine risk factors associated with PLPHs
in the neurology outpatient setting.
Methods
Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar
Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of
care, each patient was contacted by telephone by the attending physician within 2–5 days of having an LP to ascertain health status and the presence of PLPH. We performed
multiple logistic regression analysis to evaluate the association between PLPH and
needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and
Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such
as traumatic LPs, number of attempts, positioning and volume of CSF drawn.
Results
The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared
to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic
22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 0.31, 95%
CI 0.12–0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q
needle was used compared to the 22S needle (adjusted OR=3.99, 95% CI 1.32–12.0).
Conclusions
Our outpatient findings support the American Academy of Neurology recommendations
to use smaller non-traumatic needles to reduce the risk of PLPH.
Keywords
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Article info
Publication history
Published online: May 06, 2011
Accepted:
April 4,
2011
Received in revised form:
April 1,
2011
Received:
February 12,
2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
