Factors associated with the onset and persistence of post-lumbar puncture headache

Andrés E. Monserrate, Davis C. Ryman, Shengmei Ma, Chengjie Xiong, James M. Noble, John M. Ringman, John C. Morris, Adrian Danek, Felix Müller-Sarnowski, David B. Clifford, Eric M. McDade, William S. Brooks, David G. Darby, Colin L. Masters, Philip S.J. Weston, Martin R. Farlow, Neill R. Graff-Radford, Stephen P. Salloway, Anne M. Fagan, Angela OliverRandall J. Bateman, Inherited Alzheimer Network Dominantly Inherited Alzheimer Network

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


IMPORTANCE: 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). DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.

Original languageEnglish (US)
Pages (from-to)325-332
Number of pages8
JournalJAMA neurology
Issue number3
StatePublished - Mar 1 2015

ASJC Scopus subject areas

  • Clinical Neurology


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