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BMC Neurology
Published in: BMC Neurology 1/2022

Open Access 01-12-2022 | Spinal Muscular Atrophy | Research article

Post‐dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures

Authors: Jasem Al-Hashel, Azza Rady, Fathi Massoud, Ismail Ibrahim Ismail

Published in: BMC Neurology | Issue 1/2022

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Abstract

Background

Lumbar puncture (LP) is a common and relatively safe neurological procedure. It can be complicated by post-dural puncture headache (PDPH) after both diagnostic and therapeutic procedures. The aim of this study is to identify the incidence, risk factors and clinical characterization of PDPH in the inpatient setting of the main tertiary neurology hospital in Kuwait.

Methods

We conducted a prospective observational cohort study that included patients who were admitted to neurology department at Ibn Sina hospital, Kuwait, from January 1, 2019 to December 31, 2020, on whom, LP was performed for diagnostic and/or therapeutic reasons. Multivariate logistic regression analysis was performed to evaluate the association between PDPH and different clinical parameters.

Results

A total of 285 patients were included; 225 females (78.9%), mean age of 32.9 ± 11.7 years. PDPH was reported by 84 patients (29.5%), with mean headache onset of 1.7 ± 0.8 days, and mean duration of 2.4 ± 2.1 days. The commonest headache type was dull aching in 49 patients (58.3%). Headache severity was mild to moderate in 64 patients (76.2%), with mean NRS of 4.1 ± 0.9. Most PDPH (99.3%) resolved with conservative medical management, with only 2 patients (0.7%) requiring epidural blood patch. In multivariate logistic regression model, there was a statistically significant correlation between development of PDPH and young age (p = 0.001), female gender (p = 0 .001), low BMI (p < 0 .001), pre-LP headache (p = 0.001), history of previous PDPH (p = 0.001), and number of LP attempts (p < 0.001). PDPH was statistically significantly higher in patients with optic neuritis (p = 0.009), and cerebral venous thrombosis (p = 0.007), and lower in patients with peripheral neuropathy (p = 0.011) and spinal muscular atrophy (p = 0.042).

Conclusions

Findings from clinical practice in the main tertiary neurology hospital in Kuwait were in line with literature findings. Younger age, female gender, lower BMI, pre-procedural headache, previous history of PDPH, and number of LP attempts were found to be independent risk factors for developing PDPH. To our knowledge, this study represents the first comprehensive description of PDPH in a population from the Arabian Gulf Region.
Literature
1.
Bezov D, Lipton RB, Ashina S. Post‐dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. J Head Pain. 2010;50(7):1144–52.CrossRef
2.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.
3.
Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Neurology. 2000;55:909–14.CrossRef
4.
5.
Imbelloni LE, Sobral MGS and Carneiro ANG. Postdural puncture headache and spinal needle design. Experience with 5050 Cases. Rev Bras Anestesiol 2001; 51: 43–52.
6.
Wadud R, Laiq N, Qureshi FA, Jan AS. The frequency of postdural puncture headache in different age groups. J Coll Physicians Surg Pak. 2006;16:389–92.PubMed
7.
Amorim JA, Valença MM. Postdural puncture headache is a risk factor for new postdural puncture headache. Cephalalgia. 2008;28:5–8.CrossRef
8.
Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440–2.CrossRef
9.
Kiki I, Gundogdu M, Alici HA, Yildirim R, Bilici M. A simple, safe and effective approach to prevent postdural puncture headache: epidural saline injection. Eurasian J Med. 2009;41(3):175.PubMedPubMedCentral
10.
Oedit R, Van Kooten F, Bakker S, Dippel D. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomised, observer-blind, controlled clinical trial [ISRCTN 71598245]. BMC Neurol. 2005;5(1):12.CrossRef
11.
12.
Vandam LD, Dripps RD. Long-term follow up of patients who received 10 098 spinal anesthetics. JAMA. 1956;161:586–91.CrossRef
13.
Khlebtovsky A, Weitzen S, Steiner I, Kuritzky A, Djaldetti R, Yust-Katz S. Risk factors for post lumbar puncture headache. Clin Neurol Neurosurg. 2015;1(131):78–81.CrossRef
14.
Weji BG, Obsa MS, Melese KG, Azeze GA. Incidence and risk factors of postdural puncture headache: prospective cohort study design. Perioperative Medicine. 2020;9(1):1–6.CrossRef
15.
Monserrate AE, Ryman DC, Ma S, Xiong C, Noble JM, Ringman JM, Morris JC, Danek A, Müller-Sarnowski F, Clifford DB. Factors associated with the onset and persistence of post–lumbar puncture headache. JAMA Neurol. 2015;72(3):325–32.CrossRef
16.
Nath S, Koziarz A, Badhiwala JH, Alhazzani W, Jaeschke R, Sharma S, Banfield L, Shoamanesh A, Singh S, Nassiri F, Oczkowski W. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. The Lancet. 2018;391(10126):1197–204.CrossRef
17.
Leibold RA, Yealy DM, Coppola M, Cantees KK. Post-dural puncture headache: Characteristics, management and prevention. Ann Emerg Med. 1993;22:1863–70.CrossRef
18.
Lee GH, Kim J, Kim HW, Cho JW. Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study. BMC Neurol. 2021;21(1):1–8.CrossRef
19.
20.
Lybecker, Hms, et al. "Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias." Anesthesia and analgesia 70.4 (1990): 389–394.
21.
Vilming ST, Schrader H, Monstad I. The significance of age, sex and cerebrospinal fluid pressure in postlumbar puncture headache. Cephalalgia. 1989;9:99–106.CrossRef
22.
Amorim JA, Gomes de Barros MV, Valenc MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia 2012;32 (12):91–23.
23.
Wu CL, Rowlingson AJ, Cohen SR, Michaels RK, Courpas GE, Joe EM, Liu SS. Gender and post– dural puncture headache. Anesthesiology. 2006;105:613–8.CrossRef
24.
Flaatten H, Rodt S, Rosland J, Vamnes J. Postoperative headache in young patients after spinal anesthesia. Anaesthesia. 1987;42:202–5.CrossRef
25.
Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718–29.CrossRef
26.
Faure E, Moreno R, Thisted R. Incidence of postdural puncture headache in morbidly obese parturients. Reg Anesth. 1994;19:361–3.PubMed
27.
Peralta F, Higgins N, Lange E, et al. The relationship of body mass index with the incidence of postdural puncture headache in parturients. Anesth Analg. 2015;121:451–6.CrossRef
28.
Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post-lumbar puncture headaches: Experience in 501 consecutive procedures. Neurology. 1992;42:1884–7.CrossRef
29.
Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152(Suppl. 3).
30.
Ghaleb A. Postdural puncture headache. Anesthesiol Res. Practice. 2010;2010: 102967.
31.
Poukkula E. Headache following spinal anaesthesia, incidence and contributory factors. Acta Univ Ouluensis Ser D Med No. 101, Anaesth No. 3, 1983.
32.
Hatfalvi BI. Postulated mechanisms for postdural puncture headache and review of laboratory models. Clinical experience. Reg Anesth. 1995 Jul-Aug;20(4):329–36. PMID: 7577782.
33.
Blennow K, Wallin A, Häger O. Low frequency of post-lumbar puncture headache in demented patients. Acta Neurologica Scandinavica. 1993 Sep.
34.
Zetterberg H, Tullhög K, Hansson O, Minthon L, Londos E, Blennow K. Low incidence of post-lumbar puncture headache in 1,089 consecutive memory clinic patients. Eur Neurol. 2010;63(6):326–30.CrossRef
35.
Bortolani S, Stura G, Ventilii G, Vercelli L, Rolle E, Ricci F, Bergui M, Mongini T. Intrathecal administration of nusinersen in adult and adolescent patients with spinal muscular atrophy and scoliosis: Transforaminal versus conventional approach. Neuromuscul Disord. 2019;29(10):742–6.CrossRef
36.
Al-Hashel JY, Ismail II, Ibrahim M, John JK, Husain F, Kamel WA, Behbehani R, Ahmed SF. Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience. Frontiers in Neurology. 2020;11.
37.
38.
Serpell MG, Hadane GJ, Jamieson DR, Carson D. Prevention of headache after lumbar puncture: questionnaire survey of neurologists and neurosurgeons in United Kingdom. BMJ. 1998;316:1709–10.CrossRef
39.
Nielsen LN, Vamosi M. Risk Factors for Developing Postlumbar Puncture Headache: A Case-Control Study. J Neurosci Nurs. 2020;52(6):322–7.CrossRef
40.
41.
Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4(1):595–602.PubMedPubMedCentral
42.
MacArthur C, Lewis M, Knox EG. Accidental dural puncture in obstetric patients and long term symptoms. BMJ. 1993;306(6882):883–5.CrossRef
43.
Tien JC, Lim MJ, Leong WL, Lew E. Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore. Int J Obstet Anesth. 2016;1(28):34–8.CrossRef
44.
Basurto Ona X., Osorio D., Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015:CD007887.
45.
de Almedia, Duits F.H., Martinez-Lage P., Paquet C., Engelborghs S., Lleo A., Hausner L. Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study. Alzheimers Dement. 2016;12:154–163.
46.
Fournet-Fayard A, Malinovsky JM. Post-dural puncture headache and blood-patch: theoretical and practical approach. InAnnales Francaises D'anesthesie et de Reanimation 2013 Apr 6 (Vol. 32, No. 5, pp. 325–338).
Metadata
Title
Post‐dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures
Authors
Jasem Al-Hashel
Azza Rady
Fathi Massoud
Ismail Ibrahim Ismail
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-022-02785-0

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