Lumbar punctures with CSF analysis are often used to diagnose conditions such as meningitis, encephalitis, leukemia, autoimmune diseases, normal pressure hydrocephalus, benign intracranial hypertension (pseudotumor cerebri), and more. Lumbar punctures can also be used to inject antibiotics, antifungals, cancer medications, or local anesthetics as they enable the drug to enter the nervous system directly.
Post lumbar puncture headaches, also known as post-dural puncture headaches, occur in a quarter of patients who undergo spinal taps.
This comprehensive guide shares what clinicians should know about lumbar puncture headaches.
What Does a Lumbar Puncture Entail?
During a lumbar puncture procedure, a hollow needle is inserted into the subarachnoid space, or the spinal column in the lower back, between two vertebrae, or lumbar bones.
The lumbar puncture has a variety of applications. It measures the pressure of the cerebrospinal fluid, provides a pathway for injected medication, and can be done to withdraw samples of cerebrospinal fluid. The cerebrospinal fluid encapsulates the brain and spinal cord to protect them from injury.
The sample is then used to diagnose infections, bleeding, cancers, or other disorders that may impact the central nervous system.
What Causes a Headache After a Lumbar Puncture?
A lumbar puncture headache typically happens when the site of the needle insertion does not close, causing cerebrospinal fluid to leak from the spinal canal through the dura.
This leads to a headache as the brain is left floating in cerebrospinal fluid. When it does so, the brain may “sink” when the patient sits upright, putting pressure on the outer layer of the nerves.
Pregnant people, individuals with a low body mass index (BMI), women between the ages of 20 and 40 years, and people with a history of post-dural puncture headache (PDPH) are at higher risk of developing a lumbar puncture headache.
What Do Lumbar Puncture Headaches Feel Like?
Lumbar puncture headaches can begin shortly after a spinal tap procedure, typically within 48 hours. For a headache to be classified as a lumbar puncture headache, it must occur within five days of the lumbar puncture or spinal anesthesia.
The headaches typically cause a dull ache as opposed to a sharp stabbing pain associated with ice pick headaches. The pain typically affects both the front and back of the head and may vary in severity.
Lumbar puncture headaches may also be accompanied by other side effects such as:
- Hypotension
- Increased heart rate
- Neck pain
- Backache
- Dizziness
- Vomiting
- Photophobia
- Nausea
The exact timeframe for how long a headache lasts varies, but it usually persists between a few hours and several days. If the leak is sealed, the headache may resolve sooner.
If a patient experiences a severe headache for more than five days after the procedure, it may be due to an underlying medical condition. This is especially true if confusion, stiffness, or changes in vision accompany the headache. Prompt medical intervention is crucial in such scenarios to quickly identify and address any serious issues.
Lumbar Puncture Headache Treatment
There is no way to guarantee the absence of lumbar puncture headaches. They also often improve without medical intervention.
However, if a patient is experiencing an extremely severe headache, they may require an epidural blood patch. This procedure is expected to significantly improve the patient’s condition in 61% to 98% of cases. It involves injecting a small volume of autologous blood into the patient’s epidural space to stop the cerebrospinal fluid from leaking.
Pain Management for a Lumbar Puncture Headache
An epidural blood patch can offer immediate relief for a lumbar puncture headache. However, patients may have contraindications for this treatment such as coagulopathy/anticoagulation or an infection at the site of injection.
Efficient pain management is thus the only option for these patients if an epidural blood patch treatment is not a possibility.
In such situations, caffeine is often recommended as it can help stimulate the production of cerebrospinal fluid, thus reducing the headache. Caffeine also decreases dilated blood vessels in the brain because of its ability to act as a vasoconstrictor, which can help relieve pain.
Depending on the patient’s tolerance, they can have up to two cups of coffee a day to reduce their headaches.
Lumbar puncture headaches are also more severe when the patient is upright as the position increases the pressure on the nerves. Patients should thus be encouraged to lie down and rest as much as possible.
Over-the-counter medications to reduce pain are also excellent options for patients who cannot undergo epidural blood patches. This includes acetaminophen such as Tylenol, or ibuprofen like Advil.
Proper hydration is also important as it reduces the amount of cerebrospinal fluid leakage, or increases the volume of the cerebrospinal fluid.
Patients must thus be advised to drink plenty of fluids after their spinal tap procedure to help relieve their headaches.
Final Thoughts
Headaches can be extremely debilitating and significantly impact a patient’s recovery and quality of life.
Though spinal tap procedures are essential for effective and efficient healthcare, they can also cause severe headaches which can cause other complications. Understanding what causes a lumbar puncture headache, how it can be treated, and how patients can manage their pain at home is crucial for enhancing healthcare services.
We covered several essential facts about lumbar puncture headaches but if you want to learn more, Hospital Procedure Consultants’ Lumbar Puncture Course can provide you with more thorough information and training. The curriculum includes live training and simulators to help you enhance your skills and confidence in handling lumbar puncture procedures.
Resources:
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Schyns-van den Berg, A. Gupta, A. Postdural puncture headache: Revisited. Review Best Pract Res Clin Anaesthesiol. 2023 Jun;37(2):171-187. doi: 10.1016
Soni, N. Franco- Sadud, R. Schnobrich, D. Dancel, R. Tierney, D. Salame, G. Restrepo, M. McHardy, P. Ultrasound guidance for lumbar puncture. Neurol Clin Pract. 2016 Aug; 6(4): 358–368.doi: 10.1212
Ljubisavljevic. S. Postdural puncture headache as a complication of lumbar puncture: clinical manifestations, pathophysiology, and treatment. Review Neurol Sci. 2020 Dec;41(12):3563-3568. doi: 10.1007
Soni, N. Franco-Sadud, R. Kobaidze, K. Schnobricj, D. Salame, G. Lenchus, J. Kalidindi, V. Mader, M. Haro, E. Dancel, R. Cho, J. Grikis, L. Lucas, B. Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine. J Hosp Med. 2019 Oct; 14(10): 591–601. doi: 10.12788