Procedural and patient-related factors play differential roles in postdural puncture headache

TL;DR

This study identifies patient and procedure-related factors influencing postdural puncture headache, showing patient history is more important for development, while procedure factors affect timing.

Contribution

The study is the first to detail previous headache features and distinguish risk factors for immediate and delayed postdural puncture headache.

Findings

Longer and more frequent prior headache attacks are independent risk factors for postdural puncture headache.

Lower cerebrospinal fluid volume collected and acetazolamide use are linked to immediate-onset headaches.

Migraine with osmophobia increases the risk of postdural puncture headache.

Abstract

The incidence of postdural puncture headache varies depending on the multifactorial nature of the risk factors. Patient-related and procedure-related risk factors are still controversial. In this prospective observational study, we aimed to evaluate the risk factors for postdural puncture headache, the effect of previous headache features on the development of postdural puncture headache, and the risk factors for the immediate or delayed postdural puncture headache.

We prospectively analyzed 116 patients who underwent lumbar puncture for diagnostic or therapeutic purposes. All clinical and laboratory findings, previous headache history, and the features and information related to the lumbar puncture procedure were evaluated.

We found that the presence of longer and more frequent attacks, independent of the type of the prior headache, and a history of migraine accompanied by osmophobia are independent risk factors for postdural puncture headache. A lower volume of cerebrospinal fluid collected, higher frequency of previous headache attacks, diagnosis of idiopathic intracranial hypertension, and acetazolamide use were risk factors for the immediate-onset postdural puncture headache.

This is the first study to detail the previous headache features in the development of postdural puncture headache and to extensively examine the risk factors for immediate and delayed postdural puncture headache. It was shown for the first time that patient-related factors may be more important in terms of the development of postdural puncture headache, and procedure-related factors gain importance in terms of its time of occurrence.

Figures