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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spinal anaesthesia, is nowadays one of the safest anaesthetic techniques with low complication rates. Postspinal headache is a complication of spinal anaesthesia. This paper presents several factors associated with the development of postspinal headache and discusses the reduction, prediction and treatment of postspinal headache.
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PMID:[Postspinal headache as an anesthesiology problem]. 134 46

Post-lumbar puncture headache (PLPHA) and spontaneous hypoliquorrheic headache are both associated with low spinal fluid pressure. A dull or throbbing occipital ache characteristically worsened by sitting or standing and eased by lying down is peculiar to both. Additional symptoms and signs may accompany the headache. In PLPHA the pain is triggered by leakage of cerebrospinal fluid through the dural rent, but the cause of the pain is probably due to intracranial arterial and venous dilatation. The same mechanism probably applies to spontaneous hypoliquorrheic headache in which the site of leakage is rarely found. The majority of cases subside without treatment over several days. Those that persist may be treated with epidural blood patch or saline infusion with good results. A simple, innocuous, yet underutilized form of treatment is caffeine sodium benzoate. This review will discuss the incidence, pathogenesis, prevention and treatment of these headaches.
Headache 1990 Feb
PMID:Headaches associated with low spinal fluid pressure. 218 67

A case is presented of a 12-year-old boy with a post-lumbar puncture headache of 6 weeks duration that was treated successfully with an epidural blood patch. Post-lumbar puncture headache in children is an uncommon event. The incidence can be reduced by using a spinal needle no larger than 22 gauge to minimize the size of the dural puncture and subsequent leak of CSF. When a post-lumbar puncture headache occurs, conservative treatment with bedrest, hydration, analgesics, and psychologic support is usually all that is required. When a post-lumbar puncture headache lasts more than 1 week and other diagnoses have been excluded, an epidural blood patch performed by an experienced physician usually provides prompt and complete relief of symptoms with minimal risk.
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PMID:Prolonged headache after lumbar puncture. Successful treatment with an epidural blood patch in a 12-year-old boy. 236 47

Two types of intradural needles, 25 gauge (Qincke bevel) and 24 gauge (Sprotte type bevel) in 535 intradural anaesthesias were compared. Sprotte type needle is a modification of the Withacre needle. Postspinal total headache had an incidence of 8.9%, being significantly less (p less than 0.01) with the Sprotte needles (4.9 versus 11.8%). Spinal headache were significantly more frequent in women and in patients with an age less than 40 years, and there was no significance between the two needles when patients were older than forty. We conclude that Sprotte bevel needle decreases significatively the incidence of post-puncture headache if the patients are younger than forty, but it is an important fact that the different factors involved: age, sex and needle type, might be taken into account when we need conclusions to be drawn.
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PMID:[Influence of needle bevel, age and sex on the appearance of post-puncture headaches]. 278 79

Post-lumbar puncture headache is a common complication of dural puncture. Treatment of severe cases with an epidural 'blood patch'--injection of 10-20 ml autologous blood into the epidural space at the site of the dural puncture--is an effective and safe method with few and generally mild complications. The method has been used by anesthesiologists for many years with good results, but only rarely by radiologists, neurologists and other specialists who often perform lumbar punctures. The technique of 'blood patching,' its indications, effects, and complications and the epidural blood patch as post-lumbar puncture headache prophylaxis are discussed.
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PMID:Epidural blood patch in the treatment of post-lumbar puncture headache. 331 1

The so-called "atraumatic" needle was developed by modification of two essential features of the Whitacre Spinal needle. The new atraumatic needle tip is universally suitable for all single-shot techniques of regional anesthesia. This is the result of a 6-year test period with 34,950 applications of 24- and 22-Gauge needles in spinal anesthesia, diagnostic lumbar puncture, peridural anesthesia, plexus anesthesia, peripheral nerve blocks with a Teflon-coated version (unipolar electrostimulation), and lumbar sympathetic and celiac plexus blocks. Postspinal headache was observed following 0.02% of punctures for anesthetic or diagnostic purposes. Transient monosymptomatic nerve damage occurred in 1 case after axillary block (0.009%). No permanent neurological sequelae were observed due to vascular, neural, or dural lesions. In comparison, 10 cases of persistent traumatic nerve damage were reported to be caused by conventional needles during the last decade. An analysis of these cases reveals some reasons for underestimating the risk of neurological sequelae after regional anesthesia. The routine clinical use of this type of atraumatic needle revealed no disadvantages with regard to efficacy of nerve blocks or training of anesthetists. Due to the extremely low incidence of postspinal headache, this needle has been used for spinal therapy and diagnostic lumbar punctures in outpatient pain therapy for 2 years. As of this time, the overall risk of outpatient lumbar puncture cannot be estimated. Our experience should encourage further controlled studies to evaluate criteria for excluding those patients unsuited for outpatient spinal anesthesia and lumbar puncture.
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PMID:[An "atraumatic" universal needle for single-shot regional anesthesia: clinical results and a 6 year trial in over 30,000 regional anesthesias]. 365 34

Spinal anaesthesia was performed with a 22-gauge needle on 112 consecutive patients above fifty years of age admitted for transurethral surgery. Patients were randomly allocated to either 24 h of recumbency (group A) or ambulation as soon as the spinal had worn off (group B). Postspinal headache was found in 14% of the patients in the recumbency group and in 11% of the patients in the group of early ambulation. There were no differences between the groups regarding incidence, time of onset and duration of postspinal headache. Based on the literature and the present investigation, early ambulation is therefore recommended.
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PMID:[Postspinal headache. Is 24-hour flat bedrest a preventive measure?]. 396 Dec 22

Spinal anaesthesia was performed in 776 adult patients with 22 G and 25 G spinal needle. The incidence of postdural puncture headache was 3.5%. Its association to age, sex, needle size, duration of postoperative recumbency was analyzed. Our results show that the age was a significant predictor of postlumbar puncture headache. Postspinal headache was more often found in younger patients (p < 0.001).
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PMID:[Postspinal headache--incidence and prognosis]. 786 77

Headache following lumbar puncture is a well known and well described complication. Various manoeuvres have been tried to prevent post lumbar puncture headache--the commonest being bed rest for 4 to 24 hours following lumbar puncture, though its value is questionable. Randomised controlled clinical trial was done to evaluate the effect of 24 hours bed rest on the incidence and severity of post lumbar puncture headaches. Two hundred and eight patients were randomly allocated to either the ambulant or the bed rest group. Patients were interviewed by a single investigator on days 0, 1, 2 and 7 about the presence and nature of headache. Other relevant clinical and laboratory data pertaining to the lumbar puncture was collected. The overall incidence of post lumbar puncture headache was 17%; 15% in the ambulant and 18% in the bed rest group. Of the patients who had headaches, severe headache was observed in 57% in the ambulant and 12% in the bed rest group (p = 0.02). Other variables did not alter the outcome of headaches. Bed rest does not appear to alter the incidence of post lumbar puncture headaches, but reduces the severity in those who get headaches, after a lumbar puncture.
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PMID:Post lumbar puncture headache: is bed rest essential? 1122 16

Headache after lumbar puncture (PPH) is a common clinical problem, and occurs more frequently in patients with prepuncture headache. Bedrest after extraction of the needle has been recommended as prophylaxis for over a century. In a nation-wide survey, it was found that a majority of Swedish clinics kept all patients in a recumbent position for 30-90 minutes or longer. Many patients find enforced bedrest after lumbar puncture disagreeable, and every second person does not follow the recommendation. There is no good evidence from randomised trials to suggest that routine bedrest after dural puncture is beneficial. On the contrary, there are data in support of an increase of PPH after prolonged recumbency. Presumably, all cases should not be handled similarly. Based on present knowledge, it is suggested that patients free of headache during the last week before lumbal puncture are to be mobilised immediately.
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PMID:[Prophylactic bedrest against post-lumbar puncture headache should not be routinely used in all patients]. 1500 41


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