Incidence of Post-Dural Puncture Headache in Research Volunteers

• Published in: Headache Vol. 51; no. 10; pp. 1503 - 1510
• Main Authors: de Almeida, Sérgio Monteiro, Shumaker, Stephanie D., LeBlanc, Shannon K., Delaney, Patrick, Marquie-Beck, Jennifer, Ueland, Susan, Alexander, Terry, Ellis, Ronald J.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2011; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Body mass index; cerebrospinal fluid; Cross-Sectional Studies; dural puncture headache; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Headaches; HIV; Human immunodeficiency virus; Humans; Incidence; Longitudinal Studies; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Post-Dural Puncture Headache - diagnosis; Post-Dural Puncture Headache - epidemiology; Post-Dural Puncture Headache - etiology; post-lumbar puncture headache; Prospective Studies; Risk Factors; Vascular diseases and vascular malformations of the nervous system; Volunteers; Human; Headache; Nervous system diseases; Cerebrospinal fluid; Lumbar puncture; Cerebral disorder; Incidence; Pain; HIV; Central nervous system disease; dural puncture headache; Neurological disorder; Cerebrovascular disease; post-lumbar puncture headache
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2011.01959.x

Objective.— To determine the frequency and risk factors of post‐dural puncture headache (PDPH) in research volunteers. Background.— Despite increasing interest in measuring cerebrospinal fluid (CSF) biomarkers to investigate disease pathogenesis and diagnosis, previous case series have evaluated lumbar puncture (LP) safety only in clinical care. PDPH is a common complication after LP. Methods.— We determined the frequency of PDPH in neurologically unselected HIV seropositive and seronegative adults volunteering for research, as well as the variables associated with the development of PDPH. Variables studied were body mass index (BMI), HIV serostatus, volume of CSF removed, number of previous LPs, use of pre‐medication, LP position, lumbar space, number of needle passes, whether or not aspiration was used, CSF white blood cell counts, CSF red blood cell counts, CD4 count, CD4 nadir, CSF HIV viral load, plasma HIV viral load, and race. Results.— Of 675 LPs performed over 1 year, headache developed in 38 (5.6%; 95% CI 4.2, 7.1). Most PDPH (92%) resolved spontaneously or with conservative medical management; 3 required epidural blood patch. Greater headache risk was associated with lower BMI (BMI ≤25 vs >25) (OR 3.3; CI 95% 1.5, 7.0; P = .001) and less prior LP experience (previous LPs ≤2 vs >2) (OR 2.1; CI 95% 1.1, 4.1; P = .03). PDPH was not significantly (P > .05) related to HIV serostatus, CSF volume, or gender. Conclusion.— In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self‐limited.