Article Text

Download PDFPDF

Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention.
  1. J W Clark,
  2. G D Solomon,
  3. P D Senanayake,
  4. C Gallagher
  1. Department of Neurology, Scott & White Clinic, Temple, Texas 76508, USA.


    Medical treatment of postlumbar puncture headache (post-LP HA) is often difficult and ineffective. Prevention would be preferable to more invasive procedures, including blood patch. The aim was to determine the incidence of post-LP HA in two suspected high risk groups compared with the general outpatient population. Based on previous research, it was hypothesised that a low substance P concentration, or a history of chronic headache, or both would be associated with a higher risk of post-LP HA. A total of 310 randomly selected patients undergoing diagnostic lumbar puncture in the outpatient neurology clinic over 30 consecutive months were studied. Follow up was by headache questionnaire or phone survey after diagnostic lumbar puncture. Substance P was measured by radioimmunoassay on a subset of 102 samples of CSF. The overall incidence of post-LP HA was 38%. Patients with a measured substance P value < 1.3 pg/ml were three times as likely to have post-LP HA than those with a higher value. A history of chronic or recurrent headache was reported by 57% of those who developed post-LP HA. This group was also three times as likely to experience post-LP HA as those who did not have chronic headaches.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Linked Articles

    • Research Article
      K V Toyka