Risk factors for post lumbar puncture headache

• Lumbar puncture (LP) is complicated by headache in about one-third of patients.
• 144 Patients undergoing diagnostic LP completed questionnaires.
• The questionnaires included questions about fear of the procedure and pre-existing headache.
• Fear of the procedure does not predispose to occurrence of post-LP headache (PLPH).
• History of headache and elevated intracranial pressure predispose to PLPH.

BackgroundLumbar puncture (LP) is complicated by headache in about one-third of patients. The aim of the study was to evaluate potential risk factors for post-LP headache.Methods144 Patients undergoing diagnostic LP at a tertiary medical center completed questionnaires on fear of the procedure, pre-existing headache, and post-LP headache. Data on patient demographics, operator experience, and other procedure-related parameters were collected from hospital files.ResultsThe post-LP headache group (n = 37, 27.6%) was characterized by a significantly younger age and higher proportion of women relative to the no-headache group (n = 97); body mass index was similar. Both groups had similar levels of fear of the procedure and there was no correlation between intensity of patients’ anxiety to the procedure and its occurrence. Patients with high opening pressure had higher levels of post-LP headache (28.6% vs. 18% p = 0.078) and a history of headaches was significantly more prevalent in the post-LP-headache group (66.6% vs. 38.1%, p = 0.003).ConclusionsFear of the procedure does not predispose to occurrence of post-LP headache while a history of headache and elevated intracranial pressure does. These findings may be related to the possible pathophysiology of the condition, namely a change in compliance and pressure gradients with resultant venous distention.