title: Postdural puncture headache: impact of needle type, a randomized trial.
abstract: BACKGROUND
  The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times.
  
  
  OBJECTIVE
  The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence.
  
  
  METHODS
  The study is based on a prospective, randomized, and simple-blinded clinical trial.
  
  
  METHODS
  Patients older than 14 years were scheduled for a diagnostic or therapeutic LP.
  
  
  METHODS
  The outcome measure included the development of PDPH according to the International Headache Association criteria.
  
  
  METHODS
  Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH.
  
  
  RESULTS
  The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective.
  
  
  CONCLUSIONS
  We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain. Electronic address: anacastrillosanz@yahoo.es.
authors: Ana
authors: A
authors: Castrillo
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: César
authors: C
authors: Tabernero
authors: Multiprofessional Education Unit for Family and Community Care, Madrid (South-East), C/ Hacienda de Pavones 28030, Spain.
authors: Luis M
authors: LM
authors: García-Olmos
authors: Division of Neurology, General Hospital, Burgos, Spain.
authors: Cecilia
authors: C
authors: Gil
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Raúl
authors: R
authors: Gutiérrez
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: María I
authors: MI
authors: Zamora
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Amelia
authors: A
authors: Mendoza
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: María F
authors: MF
authors: Rodríguez
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Pilar
authors: P
authors: Guerrero
authors: Division of Neurology, General Hospital, Burgos, Spain.
authors: Jaime S
authors: JS
authors: Rodríguez-Vico
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Marta
authors: M
authors: Ferrero
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Noemí
authors: N
authors: Morollón
authors: Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
authors: Jacinto
authors: J
authors: Duarte
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects* / Q000295:instrumentation*
keywords: Atraumatic; Cerebrospinal fluid; Headache; Lumbar puncture; Spinal needle; Traumatic