From the Guidelines
Post lumbar puncture headaches are best treated with a combination of conservative measures, including adequate hydration, regular multimodal analgesia with acetaminophen and nonsteroidal anti-inflammatory drugs, and caffeine, as recommended by the most recent consensus practice guidelines 1.
Initial Treatment
Initial treatment should focus on:
- Adequate hydration with oral fluids, and intravenous fluid if oral hydration cannot be maintained 1
- Regular multimodal analgesia, including acetaminophen and nonsteroidal anti-inflammatory drugs, unless contraindicated 1
- Caffeine may be offered in the first 24 hours of symptoms with a maximum dose of 900 mg per day (200-300 mg if breastfeeding) 1
Invasive Interventions
If these conservative measures fail after 24-48 hours and the headache remains severe, an epidural blood patch should be considered, as recommended by the consensus practice guidelines 1.
- The procedure involves injecting 15-20 mL of the patient's own blood into the epidural space at or near the original puncture site, creating a seal that prevents further CSF leakage 1
- The blood patch is highly effective, providing immediate relief in about 70-90% of patients
Prevention
Prevention is also important, and using smaller gauge needles (22-24G), non-cutting needle tips (pencil-point), and proper patient positioning during the procedure can significantly reduce the risk of post-lumbar puncture headaches, as recommended by a clinical practice guideline 1.
- Atraumatic needles are more expensive, but evidence suggests that they reduce costs overall compared with conventional needles 1
- The use of atraumatic needles is a strong recommendation for all patients (adults and children) undergoing lumbar puncture, as they decrease complications and are no less likely to work than conventional needles 1
From the Research
Treatment Options for Post Lumbar Puncture Headache
- Conservative treatments for mild post lumbar puncture headache (PDPH) include bed rest and oral caffeine 2, 3, 4.
- For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment, although it is an invasive procedure with inherent risks 2, 3, 5.
- Other less invasive treatments that have shown promise include epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, and greater occipital nerve blocks 2.
- The use of thin, atraumatic needles and special puncture techniques can help prevent PDPH 3, 5, 6.
Non-Pharmacological Interventions
- Bed rest does not appear to alter the incidence of post lumbar puncture headaches, but may reduce the severity in those who experience headaches 4.
- Early mobilization and avoidance of prolonged bed rest are recommended 4, 6.
- Hydration and maintaining a sealed puncture site may also be beneficial 6.