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OVER 100 YEARS OF POST LUMBAR PUNCTURE HEADACHE, AND COUNTING
  1. A Davis1,2,*,
  2. MD Espasandin1,2,
  3. K Schmierer1,2
  1. 1Barts and The London NHS Trust
  2. 2Queen Mary University of London School of Medicine and Dentistry

    Abstract

    Background Post-lumbar puncture headache (PLPHA) occurs in up to 1/3 of patients undergoing lumbar puncture (LP). Evidence suggests the frequency of PLPHA can be reduced using atraumatic needles instead of cutting (Quincke) needles. However, Quincke needles remain standard in UK neurology departments. As part of a service audit we recorded frequency and severity of PLPHA in patients on our daycase unit.

    Methods LPs were performed using Quincke needles in an unselected group of 38 patients by a single examiner (AGD). Standardised telephone consultations at defined timepoints (days 2 and 7 post-LP) were used to collect data on the presence, intensity and duration of PLPHA.

    Results 23 women and 15 men aged 42.2 years (22–74) were included. 22 patients (58%) reported PLPHA at day 2 (mean severity 3.1/5), of whom eight patients (36%) continued to suffer from headache at day 7 (mean severity 2.4/5). Mean duration of PLPHA was 4.6 days (median 4 days). seven patients (18%) had PLPHA for more than 7 days. Three patients consulted their GP and three attended A and E due to PLPHA. Two patients had to be re-admitted and one required treatment using a blood patch.

    Conclusion Our data suggest PLPHA is a common complication of diagnostic LPs causing significant distress to patients and cost to the NHS. To reduce the burden a switch from traumatic to atraumatic needles should be considered. Further LPs are currently being carried out to complete a dataset of 50 LPs using Quincke and 50 using atraumatic needles.

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