D. Blood patch – Explanation
Post-lumbar puncture headache
Headache following lumbar puncture (LP) occurs in approximately one-third of patients. The
pathophysiology of is unclear but may relate to a ‘leak’ of CSF following dural puncture. Post-LP
headaches are more common in young females with a low body mass index
Typical features
- usually develops within 24-48 hours following LP but may occur up to one week later
- may last several days
- worsens with upright position
- improves with recumbent position
| Factors which may contribute to headache | Factors which do not contribute to headache |
| Increased needle size Direction of bevel Not replacing the stylet Increased number of LP attempts |
Increased volume of CSF removed Bed rest following procedure Increased fluid intake post procedure Opening pressure of CSF Position of patient |
Management
- supportive initially (analgesia, rest)
- if pain continues for more than 72 hours then specific treatment is indicated, to prevent subdural
haematoma - treatment options include: blood patch, epidural saline and intravenous caffeine
