title: Factors associated with the onset and persistence of post-lumbar puncture headache.
abstract: OBJECTIVE
  This study assesses factors associated with the most common adverse event following lumbar puncture.
  
  
  OBJECTIVE
  To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH).
  
  
  METHODS
  We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects.
  
  
  METHODS
  We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected.
  
  
  RESULTS
  The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles.
  
  
  CONCLUSIONS
  Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.
authors.affiliation: University of Puerto Rico School of Medicine, San Juan2Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Andrés E
authors.initials: AE
authors.lastname: Monserrate
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri4Dominantly Inherited Alzheimer Network Clinical Core, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Davis C
authors.initials: DC
authors.lastname: Ryman
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Shengmei
authors.initials: S
authors.lastname: Ma
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Chengjie
authors.initials: C
authors.lastname: Xiong
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: James M
authors.initials: JM
authors.lastname: Noble
authors.affiliation: Mary S. Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles.
authors.forename: John M
authors.initials: JM
authors.lastname: Ringman
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri5Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
authors.affiliation: Department of Neurology, Ludwig-Maximilians Universität Munich, Munich, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Danek
authors.affiliation: Department of Neurology, Ludwig-Maximilians Universität Munich, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Müller-Sarnowski
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: David B
authors.initials: DB
authors.lastname: Clifford
authors.affiliation: Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Eric M
authors.initials: EM
authors.lastname: McDade
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney.
authors.forename: William S
authors.initials: WS
authors.lastname: Brooks
authors.affiliation: The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Darby
authors.affiliation: The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Colin L
authors.initials: CL
authors.lastname: Masters
authors.affiliation: School of Life and Medical Sciences,University College London, London, England.
authors.forename: Philip S J
authors.initials: PS
authors.lastname: Weston
authors.affiliation: Indiana Alzheimer Disease Center, Indiana University, Indianapolis.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Farlow
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Neill R
authors.initials: NR
authors.lastname: Graff-Radford
authors.affiliation: Memory and Aging Program, Butler Hospital, Brown Medical School, Providence, Rhode Island.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Salloway
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Fagan
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri5Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Angela
authors.initials: A
authors.lastname: Oliver
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Bateman
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D051299:Post-Dural Puncture Headache / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000009:adverse effects* / Q000639:trends*; D013997:Time Factors