Protocol to avoid post-dural puncture headache after large-volume cerebral spinal fluid extraction in a prospective...

Lumbar puncture (LP) to extract cerebral spinal fluid (CSF) to quantify analytes relevant to brain health can lead to post-dural puncture headache (PDPH). Incidences vary across studies. This prospective memory clinic study assessed the incidence and intensity of PDPH after protocolised extraction and post-procedural rest. Patient and procedural risk factors for PDPH were explored. In 724 patients or healthy volunteers we performed 1147 procedures with intravenous infusion of 500 ml of 0.9% saline, LP with 22-gauge non-cutting pencil point needles, CSF collection (13.5-15 ml) without negative pressure, and observed bed and chair rest for 45 min. The overall incidence of PDPH was 9.6% at 24 h and 4.7% at seven days. All PDPHs were mild to moderate and self-limited (no blood patches or hospitalisations required). Patients managed symptoms with low doses of acetaminophen or non-steroidal anti-inflammatory drugs, along with oral caffeine intake. At 24 h PDPH was significantly associated with a low (> 18.5-24.9) or very high (> 40) body mass index (P = 0.021), a history of chronic pain (P = 0.007), or a lower puncture site (P = 0.002). We conclude that protocolised extraction of large volumes of CSF with a medium-gauge non-traumatic needle, controlled fluid loading and short bed rest can lower the incidence of PDPH, favouring safe CSF research.