Research Article| Volume 306, ISSUE 1-2, P24-28, July 15, 2011

Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic



      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.


      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.


      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).


      Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.


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        • Strupp M.
        • Schueler O.
        • Straube A.
        • Von Stuckrad-Barre S.
        • Brandt T.
        “Atraumatic” Sprotte needle reduces the incidence of post-lumbar puncture headaches.
        Neurology. 2001; 57 ([12–24%]): 2310-2312
        • Linker G.
        • Mirza N.
        • Manetti G.
        • Meyer M.
        • Putnam K.T.
        • Sunderland T.
        Fine-needle, negative-pressure lumbar puncture: a safe technique for collecting CSF.
        Neurology. 2002; 59: 2008-2009
        • Evans R.W.
        • Armon C.
        • Frohman E.M.
        • Goodin D.S.
        Assessment: prevention of post-lumbar puncture headaches: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
        Neurology. Oct 10 2000; 55: 909-914
        • Raymond John R.
        • Raymond Patrick A.
        Post-lumbar puncture headache etiology and management.
        West J Med. May 1988; 148: 551-554
        • Cook P.T.
        • Davies M.J.
        • Beavis R.E.
        Bed rest and post lumbar puncture headache.
        Anaesthesia. 1989; 44: 389-391
        • Jones R.J.
        The role of recumbency in the prevention and treatment of post spinal headache.
        Anesth Analg. 1974; 53: 788-796
        • Ford C.D.
        • Ford D.C.
        • Koenigsberg M.D.
        A simple treatment of post-lumbar-puncture headache.
        J Emerg Med. Jan–Feb 1989; 7: 29-31
        • Gormley J.B.
        Treatment of post-spinal headache.
        Anesthesiology. 1960; 21: 565-566
        • Morewood Gordon H.
        A rational approach to the cause, prevention and treatment of postdural puncture headache.
        CMAJ. October 15 1993; 149: 1087-1093
        • Lavi R.
        • Yarnitsky D.
        • Rowe J.M.
        • Weissman A.
        • Segal D.
        • Avivi I.
        Standard vs. atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial.
        Neurology. 2006; 67: 1492-1494
        • Braune H.J.
        • Huffmann G.A.
        A prospective double-blind clinical trial, comparing the sharp Quincke needle (22G) with an ‘atraumatic’ needle (22G) in the induction of post-lumbar puncture headache.
        Acta Neurol Scand. 1992; 86: 50-54
        • Kleyweg R.P.
        • Hertzberger L.I.
        • Carbaat P.A.
        Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial.
        Cephalalgia. 1998; 18: 635-637
        • Muller B.
        • Adelt K.
        • Reichmann H.
        • Toyka K.
        Atraumatic needle reduces the incidence of post-lumbar puncture syndrome.
        J Neurol. 1994; 241: 376-380
        • Pan Peter H.
        • Fragneto Regina
        • Moore Charles
        • Ross Vernon
        Incidence of postdural puncture headache and backache, and success rate of dural puncture: comparison of two spinal needle designs.
        South Med J. April 2004; 97: 359-363
        • Armon C.
        • Evans R.W.
        Addendum to assessment: prevention of post-lumbar puncture headaches Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
        Neurology. 2005; 65: 510-512
        • Birnbach D.J.
        • Kuroda M.M.
        • Sternman D.
        • Thys D.M.
        Use of atraumatic spinal needles among neurologists in the United States.
        Headache. 2001; 41: 385-390
        • StataCorp.
        Stata Statistical Software: Release 10.
        StataCorp LP, College Station, TX2007
        • Hilton-Jones D.
        Post Lumbar Puncture Headache.
        Charles C. Thomas, Springfield, IL1964
        • Tourtellotte W.W.
        • Henderson W.G.
        • Tucker R.P.
        • Gilland O.
        • Walker J.E.
        • Kokman E.
        A randomized, double-blind clinical trial comparing the 22 versus 26 gauge needle in the production of the post-lumbar puncture syndrome in normal individuals.
        Headache. 1972; 12: 73-78
        • Kuntz K.
        • Kokmen E.
        • Stevens J.
        • Miller P.
        • Offord K.
        • Ho M.
        Post lumbar puncture headaches: experience in 501 consecutive procedures.
        Neurology. 1992; 42: 1884-1887
        • Vilming S.T.
        • Kloster R.
        • Sandvik L.
        The importance of sex, age, needle size, height and body mass index in post-lumbar puncture headache.
        Cephalalgia. Sep 2001; 21: 738-743