Cardiac Anesthesiologist’s blog
The incidence of post spinal puncture headache is approximately 1% in spinal anesthesia. It results from unintentional or intentional puncture of the dura membrane. In obstetrics in case of accidental dural puncture up to 80% of patients subsequently developing a post-dural puncture headache.
Headaches are caused by leakage of spinal fluid through a puncture hole in the dura mater.This leakage decreases the pressure of the spinal fluid and may cause traction on pain-sensitive intracranial structures as the brain loses support and sags.
The onset of headache is usually within 24–48 h after dural puncture or sometimes later. It is a frontal or occipital headache that worsens with the upright or seated posture and is relieved by lying supine. Associated symptoms can include nausea, vomiting, neck pain, dizziness, tinnitus, diplopia, hearing loss, cortical blindness, cranial nerve palsies, and even seizures.
Headache usually resolves within a few days ( within 7 days in the majority (72%) of cases), but the longest reported headache after lumbar puncture lasted for 19 months.
Factors contributing to the development of headache after lumbar puncture:
- Sex: Females > males
- Needle size: larger > smaller
- Number of lumbar puncture attempts
- Needle bevel: less when the needle bevel is placed in the long axis of the neuraxis
- Pregnancy: more when pregnant
- Dural punctures: more with multiple punctures
- Continuous spinal infusion
- The volume of the spinal fluid removed
- There is no convincing evidence to suggest any particular position to reduce the incidence of headache.
- The incidence of headache does not depend on the CSF opening pressure, CSF analysis or the volume of CSF removed.