Post-lumbar puncture headache


  • 10-36% of patients develop headache within 24-48hrs post-LP
  • Due to persistent CSF leak
  • Also known as "Postdural Puncture Headaches"
  • A 2018 meta analysis showed atraumatic needles had a lower incidence of post-LP headache and need for blood patch when compared to sharp needles[1]

Clinical Features

  • Worsening with upright position and relief with recumbency

Differential Diagnosis






Aseptic Meningitis


  • Normally by history


  • Simple analgesics
  • IV fluids
  • IV caffeine[2]
    • 500mg (in 1 L of NS) over 1 hour, followed by 1 L of NS x 1 hour
    • Give second dose in 4 hours if pain persists
  • Blood patch if above fails


  • Minimize risk by:
    • Orienting needle bevel parallel to longitudinal fibers of dura
    • Using smaller-bore needles (22 gauge or smaller)
    • Using atraumatic needles
    • Stylet replacement before needle removal
  • Recumbency and bedrest NOT effective

See Also


  1. Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review And Meta-Analysis Nath, S., et al, Lancet 391(10126):1197, March 24, 2018
  2. Yücel A, Ozyalçin S, Talu GK, et al. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24:51.
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