Clinical study| Volume 75, P30-34, May 2020

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Postdural puncture headache leads to clinical worsening of pre-existing chronic headache

Published:March 26, 2020DOI:


      • 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.


      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.


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        • Amorim J.A.
        • Valença M.M.
        Postdural puncture headache is a risk factor for new postdural puncture headache.
        Cephalalgia. 2008; 28: 5-8
        • Amorim J.A.
        • Gomes de Barros M.V.
        • Valenc M.M.
        Post-dural (post-lumbar) puncture headache: risk factors and clinical features.
        Cephalalgia. 2012; 32: 916-923
        • April M.D.
        • Long B.
        Does bed rest or fluid supplementation prevent post-dural puncture headache?.
        Ann Emerg Med. 2018; 71: 55-57
        • Bezov D.
        • Lipton R.B.
        • Ashina S.
        Post-dural puncture headache: Part I diagnosis, epidemiology, etiology and pathophysiology.
        Headache. 2010; 50: 1144-1452
        • Clark J.W.
        • Solomon G.D.
        • Senanayake P.D.
        • Gallagher C.
        Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention.
        J Neurol Neurosurg Psychiatry. 1996; 60 (681–668)
        • Duits F.H.
        • Martinez-Lag P.
        • Paquet C.
        • Engelborghs S.
        • Lleó A.
        • Hausner L.
        • et al.
        Performance and complications of lumbar puncture in memory clinics: results of the multicenter lumbar puncture feasibility study.
        Alzheimer’s Dementia. 2016; 12: 154-163
        • Ghaleb A.
        Postdural puncture headache.
        Anesthesiol Res Practice. 2010; 2010102967
      1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed., Cephalalgia 2018; 38(1): 1–211.

        • Khlebtovsky A.
        • Weitzen S.
        • Steiner I.
        • Kuritzky A.
        • Djaldetti R.
        • Yust-Katz S.
        Risk factors for post lumbar puncture headache.
        Clin Neurol Neurosurg. 2015; 131: 78-81
        • Kuntz K.M.
        • Kokmen E.
        • Stevens J.C.
        • Miller P.
        • Offord K.P.
        • Ho M.M.
        Post-lumbar puncture headaches: experience in 501 consecutive procedures.
        Neurology. 1992; 42: 1884-1887
        • Levine D.N.
        • Rapalino O.
        The pathophysiology of lumbar puncture headache.
        J Neurol Sci. 2001; 192: 1-8
        • Ljubisavljevic S.
        • Zidverc Trajkovic J.
        • Ignjatovic A.
        • Stojanov A.
        Parameters Related to lumbar puncture do not affect the occurrence of post dural puncture headache but may influence its clinical phenotype.
        World Neurosurgery. 2020; 133: 540-550
        • Song J.
        • Breidenbach K.
        • Penaco Duong A.L.
        • Zhang S.
        • Joseph V.
        Impact of migraine headaches and depression/anxiety on the incidence of post-dural puncture headache during postpartum course.
        AMJ. 2018; 11: 178-185
        • Valenca M.M.
        • Amorim J.A.
        • Moura T.P.
        Why do not all individuals that undergo dura mater/arachnoid puncture develop postdural puncture headache?.
        Anesthesiol Pain Med. 2012; 1: 207-209
        • Webb C.A.
        • Weyker P.D.
        • Zhang L.
        • Stanley S.
        • Coyle D.T.
        • Tang T.
        • et al.
        Unintentional dural puncture with a Tuohy needle increases risk of chronic headache.
        Anesth Analg. 2012; 115: 124-132