Factors associated with the onset and persistence of post-lumbar puncture headache

Andrés E. Monserrate; Davis C. Ryman; Shengmei Ma; Chengjie Xiong; James M. Noble; John M. Ringman; John C. Morris; Adrian Danek; Felix Müller-Sarnowski; David B. Clifford; Eric M. McDade; William S. Brooks; David G. Darby; Colin L. Masters; Philip S.J. Weston; Martin R. Farlow; Neill R. Graff-Radford; Stephen P. Salloway; Anne M. Fagan; Angela Oliver; Randall J. Bateman; Inherited Alzheimer Network Dominantly Inherited Alzheimer Network

doi:10.1001/jamaneurol.2014.3974

Factors associated with the onset and persistence of post-lumbar puncture headache

Andrés E. Monserrate, Davis C. Ryman, Shengmei Ma, Chengjie Xiong, James M. Noble, John M. Ringman, John C. Morris, Adrian Danek, Felix Müller-Sarnowski, David B. Clifford, Eric M. McDade, William S. Brooks, David G. Darby, Colin L. Masters, Philip S.J. Weston, Martin R. Farlow, Neill R. Graff-Radford, Stephen P. Salloway, Anne M. Fagan, Angela OliverRandall J. Bateman, Inherited Alzheimer Network Dominantly Inherited Alzheimer Network

Neurology

Research output: Contribution to journal › Article › peer-review

38 Scopus citations

Abstract

IMPORTANCE: This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE: To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS: We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES: We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS: The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE: Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.

Original language	English (US)
Pages (from-to)	325-332
Number of pages	8
Journal	JAMA neurology
Volume	72
Issue number	3
DOIs	https://doi.org/10.1001/jamaneurol.2014.3974
State	Published - Mar 1 2015

ASJC Scopus subject areas

Clinical Neurology

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Monserrate, A. E., Ryman, D. C., Ma, S., Xiong, C., Noble, J. M., Ringman, J. M., Morris, J. C., Danek, A., Müller-Sarnowski, F., Clifford, D. B., McDade, E. M., Brooks, W. S., Darby, D. G., Masters, C. L., Weston, P. S. J., Farlow, M. R., Graff-Radford, N. R., Salloway, S. P., Fagan, A. M., ... Dominantly Inherited Alzheimer Network, I. A. N. (2015). Factors associated with the onset and persistence of post-lumbar puncture headache. JAMA neurology, 72(3), 325-332. https://doi.org/10.1001/jamaneurol.2014.3974

Monserrate, AE, Ryman, DC, Ma, S, Xiong, C, Noble, JM, Ringman, JM, Morris, JC, Danek, A, Müller-Sarnowski, F, Clifford, DB, McDade, EM, Brooks, WS, Darby, DG, Masters, CL, Weston, PSJ, Farlow, MR, Graff-Radford, NR, Salloway, SP, Fagan, AM, Oliver, A, Bateman, RJ & Dominantly Inherited Alzheimer Network, IAN 2015, 'Factors associated with the onset and persistence of post-lumbar puncture headache', JAMA neurology, vol. 72, no. 3, pp. 325-332. https://doi.org/10.1001/jamaneurol.2014.3974

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title = "Factors associated with the onset and persistence of post-lumbar puncture headache",

abstract = "IMPORTANCE: This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE: To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS: We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES: We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS: The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE: Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.",

author = "Monserrate, {Andr{\'e}s E.} and Ryman, {Davis C.} and Shengmei Ma and Chengjie Xiong and Noble, {James M.} and Ringman, {John M.} and Morris, {John C.} and Adrian Danek and Felix M{\"u}ller-Sarnowski and Clifford, {David B.} and McDade, {Eric M.} and Brooks, {William S.} and Darby, {David G.} and Masters, {Colin L.} and Weston, {Philip S.J.} and Farlow, {Martin R.} and Graff-Radford, {Neill R.} and Salloway, {Stephen P.} and Fagan, {Anne M.} and Angela Oliver and Bateman, {Randall J.} and {Dominantly Inherited Alzheimer Network}, {Inherited Alzheimer Network}",

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doi = "10.1001/jamaneurol.2014.3974",

language = "English (US)",

volume = "72",

pages = "325--332",

journal = "JAMA neurology",

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T1 - Factors associated with the onset and persistence of post-lumbar puncture headache

AU - Monserrate, Andrés E.

AU - Ryman, Davis C.

AU - Ma, Shengmei

AU - Xiong, Chengjie

AU - Noble, James M.

AU - Ringman, John M.

AU - Morris, John C.

AU - Danek, Adrian

AU - Müller-Sarnowski, Felix

AU - Clifford, David B.

AU - McDade, Eric M.

AU - Brooks, William S.

AU - Darby, David G.

AU - Masters, Colin L.

AU - Weston, Philip S.J.

AU - Farlow, Martin R.

AU - Graff-Radford, Neill R.

AU - Salloway, Stephen P.

AU - Fagan, Anne M.

AU - Oliver, Angela

AU - Bateman, Randall J.

AU - Dominantly Inherited Alzheimer Network, Inherited Alzheimer Network

PY - 2015/3/1

Y1 - 2015/3/1

N2 - IMPORTANCE: This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE: To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS: We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES: We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS: The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE: Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.

AB - IMPORTANCE: This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE: To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS: We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES: We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS: The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE: Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.

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Factors associated with the onset and persistence of post-lumbar puncture headache

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