[Prophylactic bedrest against post-lumbar puncture headache should not be routinely used in all patients]

Abstract

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.