Post dural puncture headache (PDPH)

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Post dural puncture headache (PDPH). Use of traumatic needles: as against atraumatic needles, Large needle size. Fully referenced neurology checklist.

Risk factors

  • Use of traumatic needles: as against atraumatic needles
  • Large needle size
  • Inserting the bevel of the needle perpendicular to the direction of the nerve fibers
  • Non-replacement of stylet before needle withdrawal
  • Repeated lumbar puncture (LP) attempts

Factors unrelated to risk of PDPH

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Clinical features

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Exacerbating features

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Associated features

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Prevention

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Ineffective preventions

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Cerebrospinal fluid (CSF): features

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Magnetic resonance imaging (MRI)

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Computed tomography (CT) myelogram

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Established treatments

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Emerging treatment

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Treatments based on small trials and case reports

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Synonym

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References

  1. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J 2006; 82:713-716.
  2. Turnbull DK, Shepherd DB. Post‐dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91:718-729.
  3. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24(Suppl 1):9–160.
  4. Muller B, Adelt K, Reichmann H, Toyka K. Atraumatic needle reduces the incidence of post-lumbar puncture syndrome. J Neurol 1994; 241:376-380.
  5. Evans RW, Armon C, Frohman EM, Goodin DS.  Assessment: prevention of post‐lumbar puncture headache. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2000; 55:909–914.
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