LP Headache (Post-Dural Puncture Headache)

Risk Reduction Measures

• Needle Bevel Orientation: Insert with the bevel parallel to the dural fibres (reduces dural tear).

• Atraumatic Needle: Use the smallest gauge possible (≥22G) to minimise dural disruption.

• Stylet Replacement: Reinsert stylet before withdrawing the needle.

• Minimise Multiple Attempts: Operator experience significantly decreases the risk of post-LP headache.

Ineffective in Preventing LP Headache

• CSF Volume Removed: No proven impact on post-LP headache frequency.

• Increased Fluid Intake: Routine ‘forced fluids’ after LP is not supported by evidence.

• Bed Rest Duration: No proven benefit in preventing headache.

• LP Position (lateral decubitus vs. sitting): No clear difference in headache rates.

Key Features

• Onset: Typically within 3 days post-LP (can be delayed up to ~12 days).

• Duration: Often resolves spontaneously within 1 week; some cases need further intervention.

• Symptoms:

  • Postural headache: Worsens on standing, improves on lying flat.

  • Tinnitus, dizziness, neck stiffness, vision changes possible.

  • Nausea, photophobia may also occur in moderate to severe cases.

Management

• Conservative: Encourage lying flat if symptomatic, oral analgesics (paracetamol, NSAIDs).

• Epidural Blood Patch: Definitive treatment if severe headache persists >24–48 hours and is incapacitating.

• Hydration: Standard fluid intake, no need for forced hydration.

• Follow-Up: Advise returning if headache worsens or new neurological symptoms develop.