The lumbar puncture (LP), often known as the spinal tap, is a frequent anesthetic, therapeutic, and diagnostic operation that is the subject of this article. It may be accompanied by nausea, vomiting, tinnitus, and hearing impairment and is complicated by headache in about 1/3 of patients. It could be mild, which may last a couple of days, or severe enough to immobilize the patient and require therapy. Possible reasons behind post-LP headache include leakage of cerebro-spinal fluid (CSF) through the dural puncture site, which reduces intracranial pressure and leads to traction on pain-sensitive intracranial structures with subsequent venous distension.
It has been reported that young women with a low body mass index (BMI) are more likely to have post-LP headaches. However, additional research is going on to support it. The present study has found that pre-existing episodes of headache are a risk factor for post-LP headache. A few factors, such as the volume of spinal fluid removed, the patient's position during the procedure (supine or sitting), the opening pressure, or the constituents of the CSF, have not been found to significantly cause post-LP headache.
To explore the relationship between level of anxiety before lumbar puncture and the rate of post-LP headache, several variables were recorded, such as fear of LP test, associated
symptoms, severity, postural nature, presence of headache, location of headache, patient’s age, sex, BMI, and procedure-related data including CSF content. According to the International Headache Society (IHS), a headache of greater than 3 occurred within 24 hours of the LP test. In this present study, the highest rates of post-LP headache and a high level of fear prior to LP were seen in patients with pseudotumor cerebri and meningitis.
There are three theories proposed that create intracranial hypotension. They are as follows: (i) Post-LP CSF leak with brain sagging and dural venous sinus distension; and (ii) Post-LP venous distension with orthostatic headache. This could explain why patients with idiopathic intracranial hypertension (higher pressures between caudal and rostral areas) and meningitis (changes in dura elasticity due to inflammation) have a higher incidence of post-LP headache.(iii) Changes in the caudal and rostral parts of the CNS's compliance This may
explain the higher incidence of post-LP headache in patients with idiopathic intracranial
hypertension (higher Δ of pressures between caudal and rostral areas) and also with meningitis (changes in dura elasticity due to inflammation) and multiple sclerosis (changes in the content of the CSF because of inflammation) compared to other neurological disorders.
The above findings also support the theory of a vascular component in post-LP headache pain. It is also said that if a decrease in post-LP intracranial pressure leads to intracranial venous distension, patients with a history of headache, especially vascular types (e.g., migraine, toxic, cluster etc), may be more susceptible to the development of post-LP headache. To reduce the occurrence of headache, a few procedural measures might be effective, such as the use of a small-sized needle, reinsertion of the guide before needle withdrawal, and directing the bevel perpendicular to the dura.
References:
Khlebtovsky, Alexander; Weitzen, Sherry; Steiner, Israel; Kuritzky, Arie; Djaldetti, Ruth;
Yust-Katz, Shlomit (2015). Post-lumbar puncture headache risk factors
doi:10.1016/j.clineuro.2015.01.028
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