Sammanfattning
Background. Headache is a complication of lumbar puncture that has been known for well over a century. The aim of this paper is to provide an overview of the incidence and symptoms of, the risk factors for and the treatment of this type of headache.
Method. The article is based on a search in PubMed for studies on headache after lumbar puncture followed by a discretionary selection of publications.
Results. Post-dural puncture headache (PDPH) is characterised by the occurrence of a headache with a definite orthostatic component within five days of a lumbar puncture. The incidence depends on a number of factors. Younger women with a previous history of headaches appear to be at highest risk. The incidence can be significantly reduced by using a thin lumbar puncture needle with an atraumatic tip. The condition is self-limiting and harmless, but leads to significant morbidity. Caffeine alleviates the symptoms and reduces the course of the illness. When bed rest and caffeine prove ineffective, an epidural blood patch works well for the majority, but there is no consensus as to when such treatment should be offered.
Interpretation. Headaches frequently occur after lumbar punctures. There is substantial evidence for recommending the use of a thin, atraumatic needle to reduce the incidence. For practical reasons, a needle thinner than 22 gauge (gg) is not suitable for diagnostic lumbar punctures.