postlumbar puncture headache


postlumbar puncture headache

A headache occurring after a spinal tap, felt mostly in the front and the back of the head. It is markedly worse when the patient sits up and better when the patient lies down. The headache is sometimes associated with double vision.

Etiology

It is caused by the leakage of spinal fluid through a hole that fails to close when the spinal needle is removed from the dura mater. It is less likely to occur when pencil-point needles are used for lumbar puncture and when the spinal needle has a small diameter (e.g., 25 gauge).

Treatment

Bedrest in a completely flat and prone position (without a pillow), forced oral and intravenous fluids, and administration of cortical steroids are useful in treating the headache. If the headache persists in spite of therapy, it may be possible to stop the leakage of spinal fluid by injecting 10 ml of the patient's blood in the epidural space at the site of the lumbar puncture. The blood may “patch” the hole in the dura.

 Synonym: postdural puncture headacheSee also: headache