title: Post-lumbar puncture  headache.
abstract: BACKGROUND
  Headache is a complication of lumbar puncture that has been known for more than a hundred years. The aim of this paper is to provide an overview of the incidence and symptoms of, the risk factors for and the treatment of this type of headache.
  
  
  METHODS
  The article is based on a literature search in PubMed for studies on headache after lumbar puncture followed by discretionary selection of publications.
  
  
  RESULTS
  Post-dural puncture headache (PDPH) is characterised by the occurrence of a headache with a significant orthostatic component within 5 days of a lumbar puncture. The incidence depends on a number of factors. Younger women with a previous history of headaches appear to be at highest risk. The incidence can be significantly reduced by using a thin lumbar puncture needle with an atraumatic tip. The condition is self-limiting and harmless, but leads to significant morbidity. Caffeine alleviates the symptoms and reduces the course of the illness. When bed rest and caffeine prove ineffective, an epidural blood patch works well for the majority, but there is no consensus on when such treatment should be offered.
  
  
  CONCLUSIONS
  Headache frequently occurs after lumbar puncture. There is substantial evidence for recommending the use of a thin, atraumatic needle to reduce the incidence. For practical reasons, a needle thinner than 22 G is not suitable for diagnostic lumbar puncture.
authors.affiliation: Neurology Department, Nordland Hospital Bodø, Norway. karl.bjornar.alstadhaug@nlsh.no
authors.forename: Karl Bjørnar
authors.initials: KB
authors.lastname: Alstadhaug
authors.forename: Francis
authors.initials: F
authors.lastname: Odeh
authors.forename: Farid Khan
authors.initials: FK
authors.lastname: Baloch
authors.forename: Diana Hristova
authors.initials: DH
authors.lastname: Berg
authors.forename: Rolf
authors.initials: R
authors.lastname: Salvesen
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D002110:Caffeine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D008297:Male; D009339:Needles / Q000009:adverse effects* / Q000592:standards; D051299:Post-Dural Puncture Headache / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013129:Spinal Puncture / Q000009:adverse effects*
chemical_list: D002110:Caffeine