Highlights
- •Chronic headache (CH) patients more likely have postdural puncture headache (PDPH).
- •The clinical phenotype of CH does not have an effect on the incidence of PDPH.
- •The lumbar puncture itself does not influence the clinical worsening of CH.
- •Clinical worsening of CH appears in patients who have experienced PDPH.
- •This worsening of CH is more common in women and patients with longer history of CH.
Abstract
The incidence of postdural puncture headache (PDPH) in relation to pre-existing chronic
headache (CH) was assessed, as was the clinical course of CH, at one, three, and six
months after PDPH.
The study was conducted as a single center cohort prospective study that included
252 patients (105 men and 147 women), average age of 47.3 ± 15.0 years, on whom lumbar
puncture (LP) was performed.
PDPH was reported in 133 (52.8%) patients; CH was reported in 82 (32.5%) patients.
Patients with CH were more likely to have PDPH (p = 0.003). The individual clinical
type of CH did not have an effect on the incidence of PDPH (p = 0.128). Patients with
PDPH had a clinical deterioration of CH three and six months after LP (p = 0.047,
p = 0.027, respectively) in terms of increased headache days per month and/or incomplete
efficacy of performed therapy in relation to baseline values. Six months after LP,
the worsening of CH was more common in women with PDPH (OR 5,687 [95% CI: 1526–21,200],
p = 0.010) and patients with a longer history of CH (OR 1064 [95% CI: 1007–1124],
p = 0.027). Multivariate analysis confirmed the direct association of female sex and
duration of CH and its worsening six months after PDPH (OR 4478 [95% CI: 1149–17,452],
p = 0.031; OR 1448 [95% CI: 1292–1808], p = 0.022).
The presented results could be significant for the prediction/differential diagnosis
of PDPH in patients with CH and for the prediction/prevention of CH clinical worsening
after PDPH.
Keywords
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Article info
Publication history
Published online: March 26, 2020
Accepted:
March 20,
2020
Received:
October 9,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
