Lumbar punctures and postprocedure headaches

The practice of lumbar puncture for therapeutic and diagnostic purposes is associated with an elevated risk of developing post lumbar puncture headaches (PLPH). The headache features a severe and throbbing pain that usually develops after or within 7 days of lumbar puncture. Significant morbidity can ensue if left untreated. The exact mechanism responsible for the onset of PLPH is still unknown, but are thought to be due to cerebrospinal fluid loss. Several etiologies have been described including use of large bore needles, traumatic procedures, and an increased number of attempts. Several diagnostic and therapeutic approaches have been introduced. This chapter reviews the literature to better understand the pathophysiology, etiologies, available diagnostic and therapeutic methodologies, hurdles and prospects related to PLPHs.