Prevention of headache after lumbar puncture: questionnaire survey of neurologists and neurosurgeons in United Kingdom

The aetiology of headache after lumbar puncture is related to the hole left in the dura after the needle has been withdrawn, which allows the cerebrospinal fluid to leak out of the subarachnoid space. The headache can persist for prolonged periods and predispose to subdural haematomas, which are associated with a high mortality. Tourtellotte showed that this headache could be significantly reduced by using smaller needles.1 Also, among needles of the same size, those with atraumatic blunt tips are associated with a lower incidence of headache. They produce a smaller hole in the dura by separating rather than cutting the elastic fibres, as occurs with the Quincke tipped needles.2 We carried out a questionnaire survey of departments of neurology and neurosurgery to see if these needles were used in the practice of diagnostic lumbar puncture and to assess how else departments may be trying to prevent …