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RESEARCH PRODUCT

Postlumbar Puncture Headache Syndrome

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Publisher Summary This chapter presents a study on acute and chronic pain related to postlumbar puncture headache syndrome. The symptoms of the postlumbar puncture headache (PLPH) syndrome are positional, beginning in the upright posture and subsiding or improving when the patient reclines. Sometimes symptoms of PLPH occur spontaneously without a detectable dural defect. In these instances, suggested causes include a hyperactive resorption of cerebrospinal fluid (CSF) or a spontaneous mechanical dural hole. Magnetic resonance imaging (MRI) scans in patients with intracranial hypotension—either after LP or spontaneously—show meningeal enhancement, subdural effusions, and downward brain displacement that resolve spontaneously parallel to the clinical syndrome. In a few patients, MRI also shows abnormal dural venous sinus enhancement suggesting compensatory venous expansion to maintain adequate intracranial volume. Differential diagnosis has to exclude other types of headache, for example, cervicogenic headache, migraine without aura, meningitis, subarachnoidal hemorrhage, or complications because of subdural hematoma or intracerebral hemorrhage, especially when the symptoms show an unusual course or persist for more than 14 days. The most important diagnostic sign is the positional dependence of the symptoms The chapter discusses principles of therapy and management, including needle therapy, postural maneuvers, and symptomatic treatment.