Headache and backache after lumbar puncture in children and adolescents: a prospective study.
OBJECTIVE
After lumbar puncture, many adults develop headaches or backaches. Postpuncture complaints are believed to be rare in children and adolescents, but their exact incidence is unclear because there is a paucity of data derived from general pediatric patients. In a prospective study of general pediatric and neuropediatric patients, we investigated the frequency of postlumbar puncture headaches or backaches and factors that might influence their occurrence.


METHODS
Conducted over 12 months, the prospective study included 112 patients aged 2 to 16 years. We evaluated them for factors that might influence the rate of postpuncture complaints: age, gender, use of local anesthesia, cannula gauge, bevel orientation, number of puncture attempts, volume of cerebrospinal fluid (CSF) aspirated, and cell count in CSF.


RESULTS
Twenty-seven percent of the patients experienced headaches (positional headache in 9%), and 40% developed backache. Frequency of complaints increased in relation to patients' age. In older children, girls reported complaints more frequently than did boys. Patients with higher cell counts in CSF had more frequent headaches than did patients without pleocytosis. Cannula gauge or bevel orientation did not influence outcome.


CONCLUSIONS
The frequency of positional and nonpositional headaches after lumbar puncture is lower in children than in adults. Backaches contribute significantly to postpuncture morbidity. With puberty, the incidences of postpuncture complaints increase, and girls start to become more prone to develop postpuncture headaches. Recommendations regarding cannula gauge or bevel orientation that derive from studies in adults are not confirmed for children.
Ebinger
Friedrich
F
University Pediatric Hospital, Department of Child Neurology, Heidelberg, Germany. friedrich_ebinger@med.uni-heidelberg.de
Kosel
Christina
C
Pietz
Joachim
J
Rating
Dietz
D
D000293:Adolescent; D000367:Age Factors; D000772:Anesthesia, Local; D001416:Back Pain / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D007964:Leukocytosis; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013129:Spinal Puncture / Q000009:adverse effects*