title: Incidence of post-dural puncture headache in research volunteers.
abstract: OBJECTIVE
  To determine the frequency and risk factors of post-dural puncture headache (PDPH) in research volunteers.
  
  
  BACKGROUND
  Despite increasing interest in measuring cerebrospinal fluid (CSF) biomarkers to investigate disease pathogenesis and diagnosis, previous case series have evaluated lumbar puncture (LP) safety only in clinical care. PDPH is a common complication after LP.
  
  
  METHODS
  We determined the frequency of PDPH in neurologically unselected HIV seropositive and seronegative adults volunteering for research, as well as the variables associated with the development of PDPH. Variables studied were body mass index (BMI), HIV serostatus, volume of CSF removed, number of previous LPs, use of pre-medication, LP position, lumbar space, number of needle passes, whether or not aspiration was used, CSF white blood cell counts, CSF red blood cell counts, CD4 count, CD4 nadir, CSF HIV viral load, plasma HIV viral load, and race.
  
  
  RESULTS
  Of 675 LPs performed over 1 year, headache developed in 38 (5.6%; 95% CI 4.2, 7.1). Most PDPH (92%) resolved spontaneously or with conservative medical management; 3 required epidural blood patch. Greater headache risk was associated with lower BMI (BMI ≤25 vs >25) (OR 3.3; CI 95% 1.5, 7.0; P = .001) and less prior LP experience (previous LPs ≤2 vs >2) (OR 2.1; CI 95% 1.1, 4.1; P = .03). PDPH was not significantly (P > .05) related to HIV serostatus, CSF volume, or gender.
  
  
  CONCLUSIONS
  In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self-limited.
authors.affiliation: HIV Neurobehavioral Research Center, University of California, San Diego, CA 92103, USA.
authors.forename: Sérgio Monteiro
authors.initials: SM
authors.lastname: de Almeida
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Shumaker
authors.forename: Shannon K
authors.initials: SK
authors.lastname: LeBlanc
authors.forename: Patrick
authors.initials: P
authors.lastname: Delaney
authors.forename: Jennifer
authors.initials: J
authors.lastname: Marquie-Beck
authors.forename: Susan
authors.initials: S
authors.lastname: Ueland
authors.forename: Terry
authors.initials: T
authors.lastname: Alexander
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051299:Post-Dural Puncture Headache / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors