Empowering Patients to Reduce Lumbar Puncture Associated Spinal Headaches

Background: A post-lumbar puncture headache (PLPH) is a common complication of a lumbar puncture procedure. The traditional treatments of fluids, rest and mild analgesics work inconsistently to relieve the headaches. The invasive treatment of a blood patch is the most consistently effective treatment. Patient education typically recommends the treatments that inconsistently work. Blood patches are avoided due to their invasiveness. There has been considerable research conducted on risk factors associated with developing PLPH, prevention measures, and treatment options. This information is not readily available to nurses or to the patients.

Objective: The aim of the project was to determine from the evidence the risk factors associated with PLPH, methods for preventing them, and effective interventions for reducing them. The aim of the project was to use the information found to educate nurses who provide patient education prior and post lumbar punctures.

Design: The design of the project was a systematic review of the research literature.

Setting: An extensive search of CINAHL complete, Medline complete, and Health Source: Nursing/Academic Edition databases provided the articles for review.

Participants: Forty-one published articles evaluating reviews of literature, randomized controlled trials, quasi-experimental interventions, case-control studies, and cohort studies targeted to lower post lumbar puncture headache incidences in adults, pregnant women, and children were reviewed. Included in the analysis are 9 systematic reviews with meta-analyses, 4 reviews of literature, and 28 single research studies.

Main Outcome Measures: The outcomes measured were study recommendations regarding risk factors, prevention measures, and effective treatment strategies. A staff education program and a patient education brochure were created from the findings of this project.

Analysis: Qualitative analysis of the recommendations from the reviewed literature including a secondary analysis from a faculty mentor served as the method of analysis.

Results: Low body mass index, female, and an age of younger than 35 years old were risk factors that increased incidences of the post-lumbar puncture headache. Prevention interventions included smaller gauge needles, use of atraumatic needles (pencil-point or Whitacre), and minimal fluid removal. Some medications were inconsistently effective. The traditional interventions of fluid replacement and rest were inconsistently effective and prolonged rest was found to be ineffective.

Conclusions and Implications: Much of the research has methodological limitations, rendering it difficult to deduce conclusions across studies and further research that includes comparisons is indicated. This especially is true regarding interventions to treat PLPH. Patients should be informed that the use of a small gauge atraumatic needle and removal of a little fluid as possible lowers their risk of experiencing a PLPH. This is most important for patients with the risk factors of being female, having a low BMI, and younger than 35 years of age.

Key Words: lumbar puncture, headache, risk factors, prevention, treatment, systematic review