Medical Myth 002: Post-LP headache prevention

Case 006 – about meningoencephalitis raised a few queries amongst my nursing colleagues.  Specifically – how to prevent post-LP headaches. So I thought I would look at the data and see.  Rates of headache post-LP are reported as ~ 1/3 in most reviews

We have all been taught the way to treat / prevent post LP headache is to rest supine for x hours, increase oral fluids and use caffiene – however there is no evidence to support any of these.

The studies suggest we do single, atraumatic taps, using the smaller needles with a non-cutting tip.  Of course if you stick a 16Ga Touhy needle into somebodies arachnoid – you might want to consider a blood patch!

So in short – it is really the operator – skill and choice of kit – that makes a difference.  The stuff we ask the nursing staff to do – like bed rest, fluids, drugs etc do not really seem to make a difference.  In short – to keep the rate of headaches down you need to do a good LP with the right gear.

Casey

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