Lumbar Puncture and Post-Dural Puncture Headaches: Implications for the Emergency Physician
Volume 35, Issue 2, August 2008, Pages 149-157
Dural puncture procedures are commonly performed by various medical practitioners, including emergency physicians, for many reasons. Post-dural puncture headache (PDPH) is a relatively common complication. The degree of pain and disability caused by PDPHs is considerable. Appropriate use of smaller gauge, atraumatic needles is likely the single most important factor in reducing PDPH. Hydration and bed rest do little to prevent PDPH. Treatment of mild, nondebilitating headaches usually can be accomplished with limited activity, analgesics, and methylxanthine therapy until they resolve spontaneously. For more severe headaches, methylxanthine derivatives may be tried with epidural blood patch (EBP) as a first-line alternative or to be used if methylxanthines fail. It is helpful to use 24-gauge Sprotte spinal needles in all patients at risk for PDPH. For patients who have moderate to severe pain, cannot or do not want to remain on bed rest, and those in whom narcotic pain medication is not a practical treatment option, EBP is an appropriate first-line therapy. In general, EBP is safe, well tolerated and effective. Though the technique for epidural blood patch is not significantly more difficult than lumbar puncture, it is a procedure most commonly performed by anesthesiologists.