Post-dural puncture headache after diagnostic lumbar puncture using an atraumatic-first strategy: A retrospective cohort study: Data from a Danish neurological outpatient clinic
Amalie Vørs Thomsen, Ulrik Sodemann, Rigmor Højland Jensen, Dagmar BeierAim
Post-dural puncture headache (PDPH) is the most frequent complication of diagnostic lumbar puncture (LP). Although atraumatic needles reduce the risk of PDPH in randomized trials, real-world data from neurological outpatient practice remains limited. The aim of this study was to determine the incidence of PDPH and identify clinical predictors following diagnostic LP using a standardized atraumatic-first strategy.
Methods
We conducted a retrospective cohort study including adults undergoing diagnostic LP at a tertiary neurological outpatient clinic between September 2020 and August 2021. All procedures were initiated using a 22-gauge atraumatic needle, while 20-gauge traumatic needle was used only after unsuccessful atraumatic attempts. PDPH was defined according to the International Classification of Headache Disorders, 3rd edition criteria. Electronic medical records were reviewed for 14 days post-procedure. Because no systematic follow-up was performed, only documented cases of PDPH were captured. Associations between predefined clinical variables and PDPH were assessed using odds ratios (OR) with 95% confidence intervals (CI).
Results
Among 344 patients (mean age: 52.0 ± 17.7 years; 58.7% female), documented PDPH occurred in 14 (4.1%; 95% CI: 2.0–6.2). Three patients (0.9%) required an epidural blood patch. Seventeen patients (4.9%) required secondary use of a traumatic needle following unsuccessful atraumatic attempts. Younger age (19–50 years) was significantly associated with PDPH (OR: 8.6; 95% CI: 1.9–38.9;
Conclusion
A standardized atraumatic-first strategy was associated with a low documented incidence of PDPH in this routine neurological outpatient cohort. Younger age was the only factor significantly associated with PDPH.