How To Decrease The Risk Of A Lumbar Puncture Headache
A lumbar puncture, or spinal tap is a procedure performed collect and look at the cerebrospinal fluid surround the spinal cord and brain. During a lumbar puncture a needle is inserted into the spinal canal low in the back, or lumbar area. Cervicogenic headaches are headaches caused by the cervical spine and a doctor will usually order a lumbar puncture in order to rule out disease as a cause of discomfort. A lumbar puncture headache occurs in over 35% of patients who have had a lumbar puncture, and it usually lasts one or two days, and in some severe cases even longer. The chance of getting a headache seems to be dramatically reduced depending on the angle the needle is inserted, the replacement of the stylet, and which type of needle the anesthesiologist uses. The smaller the needle, the better your chances are of not getting a headache. The headache seems to be caused by the leakage of cerebrospinal fluid after a lumbar puncture. The pain is usually constant and occurs behind, in and around the eye. The headache seems to occur or worse within 10-15 minutes of assuming an upright position and improves or completely disappears in about 20 minutes of lying down. Post lumbar puncture headaches are more common in younger patients, and females are more likely to get them than males. These headaches occur almost twice as often in women as in men, and in both sexes those between the ages of 18 and 30 had the highest frequency. A patient’s body mass index also plays a role. Those with a small body mass index were shown to be at a greater risk of developing post-lumbar puncture headaches. There are a number of technical factors that may help reduce the chances of a lumbar puncture headache. First is the size of the needle. The smaller the needle diameter, the less risk you have of getting a headache. Smaller needles leave a smaller tear in the dura, which lessens the potential for the leakage of cerebrospinal fluid. One study reported that the incidence of lumbar puncture headaches decreased when higher gauge needles were used. Researchers found that a 16-19 gauge needle has a related headache rate of 70%, 20-22 gauge needles have a 20-40% chance of causing headaches, while 24-27 gauge needles are associated with a 5-12% chance of causing a lumbar puncture headache. The problem, however associated with using the smaller gauge needles for a lumbar puncture, is that the flow rate of the fluid would be too slow. Smaller gauge needles are usually used for spinal and epidural anesthesia. The chance for lumbar puncture headaches can also be reduced, by ensuring that the bevel of the needle being used, is inserted parallel to the dural fibers. The dural fibers run parallel to the long axis of the spine, and the insertion of the bevel at this angle will sever fewer fibers in the dura than a perpendicular angle would. Using this technicque has reduced the number headaches by about 50%. The type of needle used can also affect your chances of getting a headache. When a noncutting, atraumatic needle is used, the chances of a post lumbar puncture headache, was reduced. This type of needle has a duller tip and an oval opening below the tip. The size and type of needle used during your procedure will be determined by your physician.
To lower the chance of getting a lumbar puncture headache, you may be told to lay flat in bed with your head slightly raised for several hours. Make sure that your doctor is aware of any medications, including herbal supplements you may be taking. You may also be told to drink extra fluids after the procedure to help reduce the severity of a headache. Because your brain constantly makes new cerebrospinal fluid, the small amount of fluid that is removed during your procedure will be quickly replaced. |