Lumbar Puncture Headache…The answer is not age and sex…It’s your needle!


We have been talking about dinosaur neurologists and asking can they learn and change pratice?

Prof G and DrRuth will be tearing their hair out with dispare on reading this. It will be disappointing that we are not listening and learning.

Post-lumbar puncture headache: an adverse effect in multiple sclerosis work-up.

Vecchio D, Naldi P, Ferro V, Comi C, Leone MA, Cantello R.Neurol Sci. 2019 Jan 21. doi: 10.1007/s10072-019-3724-z. [Epub ahead of print]


Lumbar puncture (LP) is a safe procedure commonly performed in the diagnostic work-up of multiple sclerosis (MS), and its main adverse event is post-LP headache (PLPH). Predictors for PLPH in MS are not established.



To describe the occurrence of, and, factors related to PLPH in patients with suspected MS, studied on a daily-basis admission.


One hundred patients (70 females) were admitted for a diagnostic LP (standardized with a traumatic 19-G needle), observed for 6 h, and evaluated for adverse events 2 and 7 days later. Descriptive statistics and a multivariate analysis (for PLPH) were performed.


Fifty-seven (57%) patients had PLPH at 48 h, which persisted 1 week in 31, and only two presented beyond the first 2 days. Other adverse events were tinnitus and neck stiffness. None required investigations or was hospitalized. Age was the only predictor for PLPH at day 2, whereas the onset of headache within 48 h and female gender were predictors for PLPH at day 7.


PLPH is a frequent complication of LP performed on daily-basis admission in MS work-up. The maximum onset is within the first 48 h. Age and gender seem the only predictors for the appearance and persistence of PLPH.

So headache is common. But they are using a cutting needle so you get a hole and CSF fluid leaks out and you get a headache. Ask for a Sprotte non-cutting needle and make Dr Ruth happy,

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