[Headaches after lumbar puncture and their treatment]

The principle mechanism of post lumbar puncture headache is the leakage of CSF from the dural puncture site. This leads to a state of low sub-arachnoid pressure, causing traction on pain-sensitive intracerebral structures. The operator can minimise the risk of headache by selecting a needle of small diameter and ensuring that the bevel is aligned parallel to the longitudinal fibers of the dura. Current evidence suggests that the patient may be allowed to mobilise immediately. Traditional therapies such as bed rest and rehydration are usually ineffective when headache is severe. If this is the case, and the diagnosis is certain, a blood patch procedure can be performed, and repeated if necessary.