There is room for improvement in the prevention and treatment of headache after lumbar puncture

INTRODUCTION: The incidence of post dural puncture headache (PDPH) after lumbar puncture (LP) can be reduced from 36% to 0-9% by use of an atraumatic needle size 24 gauge (G)/0.56 mm rather than a traumatic needle size 22 G/0.7 mm. The evidence supporting some of the prophylactic and therapeutically treatments of PDPH is sparse. The objective of this study was to clarify which needles doctors at neurological departments in Denmark use for LP and how they treat and prevent PDPH. MATERIAL AND METHODS: The present study is a questionnaire survey among doctors employed at the 13 neurological departments in Denmark. RESULTS: A total of 161 (51%) returned the questionnaire. As for needle size, 78% stated that they used needle size 22 G, 5% used 21 G, 13% used 20 G and 3% used 18 G. Overall, 74% used traumatic needles, while 18% were unaware of the needle type used. Prophylactic bed rest was prescribed by 44%. Prescribed treatments of PDPH were caffeine, analgesics/fluid therapy and epidural blood patch (EBP). DISCUSSION: Surprisingly many of the doctors used relatively thick and/or traumatic needles although PDPH is significantly reduced when smaller atraumatic needles are used. 90% prescribed fluid therapy, but the role of fluid therapy as well as that of analgesics in the treatment of PDPH remains uncertain. There was no difference in the incidence of PDPH using prophylactic bed rest versus early mobilization. Caffeine can reduce the number of patients with persisting PDPH, while EBP is the most effective treatment for PDPH. CONCLUSION: Atraumatic needles for LP have not become standard in Danish neurological departments. Knowledge about the treatment and prevention of PDPH seems insufficient. FUNDING: not relevant.