Daily Bolus of LR: Post LP Headache

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March 23, 2011 by dailybolusoflr

Post-LP (or Post-Dural)Headache


·         Some patients develop a headache after LP

o   Typical description is a headache worsened with upright position and any valsalva maneuver

·         You should always make sure to include this as a possible complication for your LP  (Patients often laugh when I tell them this, as headache is often the indication for their headache!)

·         Most post-dural puncture headaches are self-limited, as the CSF leak from the puncture site self-resolves

·         Persistent symptoms should be treated with bed-rest and hydration

·         More persistent symptoms may require caffeine or theophylline administration and in severe and unremitting cases lasting longer than 24 hours despite aggressive maneuvers, a blood patch over the puncture site may be indicated



How to prevent it?

·         Using a pencil point needle or an atraumatic tip needle has been shown to decrease the incidence of post-dural headache

o   This is presumably due to the spreading of dural fibers (atraumatic insertion) which occurs with this type of needle, versus cutting of the fibers (traumatic insertion) which occurs with the beveled needles

·         Using a smaller diameter needle is also suggested to decrease the incidence of post-dural headache

·         Orient the bevel pointing up (up to the ceiling), when the patient is laying on their side. This allows the bevel to be parallel to the fibers of the dura and cause less trauma


·         DO NOT withdraw cerebrospinal fluid with a syringe- it should be collected by allowing it to freely flow into the collecting tubes

·         There is no supporting literature to suggest that leaving the patient in a recumbent position after a lumbar puncture decreases the incidence of post-dural headache




Roberts and Hedges




Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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