Headaches after diagnostic dural punctures

Paper p 986

In a dural puncture a needle is passed through the dura mater into the cerebrospinal fluid within the spinal canal. It is commonly performed and is indicated for diagnostic lumbar puncture, spinal anaesthesia, myelography, and intrathecal chemotherapy. The most common adverse event after the procedure is a headache. This occurs in about a third of patients after diagnostic lumbar puncture in an ambulatory setting with a 20 or 22 gauge standard Quincke bevel spinal needle.1

The aetiology of the headache from the dural puncture is most likely related to the hole left in the dura after the needle has been withdrawn. This allows the cerebrospinal fluid to leak out of the subarachnoid space, which depletes the “cushion” of fluid supporting the brain and its sensitive meningovascular covering, resulting in gravitational traction and the classic headache, which is made worse when the patient is upright and relieved on lying down.2 The headache, the onset of which is often delayed for 24 to 48 hours, usually lasts for one or …