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<p>Lumbar puncture (LP) to extract cerebral spinal fluid (CSF) to quantify analytes relevant to brain health can lead to post-dural puncture headache (PDPH). Incidences vary across studies. This prospective memory clinic study assessed the incidence and intensity of PDPH after protocolised extraction and post-procedural rest. Patient and procedural risk factors for PDPH were explored. In 724 patients or healthy volunteers we performed 1147 procedures with intravenous infusion of 500&#xa0;ml of 0.9% saline, LP with 22-gauge non-cutting pencil point needles, CSF collection (13.5–15&#xa0;ml) without negative pressure, and observed bed and chair rest for 45&#xa0;min. The overall incidence of PDPH was 9.6% at 24&#xa0;h and 4.7% at seven days. All PDPHs were mild to moderate and self-limited (no blood patches or hospitalisations required). Patients managed symptoms with low doses of acetaminophen or non-steroidal anti-inflammatory drugs, along with oral caffeine intake<b>.</b> At 24&#xa0;h PDPH was significantly associated with a low (&gt; 18.5–24.9) or very high (&gt; 40) body mass index (<i>P</i> = 0.021), a history of chronic pain (<i>P</i> = 0.007), or a lower puncture site (<i>P</i> = 0.002). We conclude that protocolised extraction of large volumes of CSF with a medium-gauge non-traumatic needle, controlled fluid loading and short bed rest can lower the incidence of PDPH, favouring safe CSF research.</p>

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Protocol to avoid post-dural puncture headache after large-volume cerebral spinal fluid extraction in a prospective observational memory clinic study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月11日

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  • Guillem Pérez-García,
  • Lluis Gallart-Gallego,
  • Olga Comps-Vicente,
  • Luis Molto-García,
  • Oriol Grau-Rivera,
  • Sandra Pradas-Méndez,
  • Anna Soteras-Prat,
  • Antonio Montes-Pérez

摘要

Lumbar puncture (LP) to extract cerebral spinal fluid (CSF) to quantify analytes relevant to brain health can lead to post-dural puncture headache (PDPH). Incidences vary across studies. This prospective memory clinic study assessed the incidence and intensity of PDPH after protocolised extraction and post-procedural rest. Patient and procedural risk factors for PDPH were explored. In 724 patients or healthy volunteers we performed 1147 procedures with intravenous infusion of 500 ml of 0.9% saline, LP with 22-gauge non-cutting pencil point needles, CSF collection (13.5–15 ml) without negative pressure, and observed bed and chair rest for 45 min. The overall incidence of PDPH was 9.6% at 24 h and 4.7% at seven days. All PDPHs were mild to moderate and self-limited (no blood patches or hospitalisations required). Patients managed symptoms with low doses of acetaminophen or non-steroidal anti-inflammatory drugs, along with oral caffeine intake. At 24 h PDPH was significantly associated with a low (> 18.5–24.9) or very high (> 40) body mass index (P = 0.021), a history of chronic pain (P = 0.007), or a lower puncture site (P = 0.002). We conclude that protocolised extraction of large volumes of CSF with a medium-gauge non-traumatic needle, controlled fluid loading and short bed rest can lower the incidence of PDPH, favouring safe CSF research.