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. 2019 Sep;59(8):1324-1338.
doi: 10.1111/head.13602. Epub 2019 Jul 24.

CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review

Jonathan H Smith  1 , Brian Mac Grory  2 , Richard J Butterfield  3 , Babar Khokhar  4 , Bryce L Falk  1 , Lisa A Marks  5
Affiliations

CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review

Jonathan H Smith et al. Headache. 2019 Sep.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Headache. 2020 Oct;60(9):2115. doi: 10.1111/head.13887. Epub 2020 Jun 5. Headache. 2020. PMID: 32996135 No abstract available.

Abstract

Objectives: (1) To perform a systematic literature review to evaluate associations between post-dural puncture headache (PDPH) and opening pressure (OP), closing pressure (CP), and volume of cerebrospinal fluid (V) removed. (2) To perform a case-control study to evaluate pressure-volume index (PVI) as a novel risk factor for PDPH.

Background: According to the International Classification of Headache Diagnoses, 3rd Edition (ICHD-3), the diagnosis of PDPH requires documentation of intracranial hypotension. However, this remains an unproven concept.

Methods: A systematic literature review was conducted, searching Cochrane Database of Systematic Reviews, Ovid EMBASE, OVID MEDLINE, Scopus, and Web of Science. Study inclusion required a comparison of headache incidence following a LP as a function of OP, CP, and/or V. A retrospective, case-control study with 1:1 matching was conducted utilizing ICHD-3 criteria. Patients with factors that could influence CSF pressure were excluded.

Results: In our case-control study, we did not identify a paired difference in either median (95% CI) elastance (0.05 [-0.09, 0.11], P = .503) or PVI (4.53 [-7.98, 19.97], P = .678). We identified 22 references, evaluating V (n = 14), OP (n = 11), and/or CP (n = 4). There was no convincing evidence for an association of PDPH with either OP or CP. A minority of studies documenting an association with V included patients with high-volume CSF removal, and/or stratified patients by the timing of the headache onset.

Conclusions: The overall risk of PDPH does not appear to be influenced by OP, CP, V or PVI. PDPH may be related to V in instances of high-volume removal, and depend on the timing of outcome assessment. Future revision of criteria should consider the existence of immediate and delayed PDPH subtypes, and not presume intracranial hypotension as a mandatory feature.

Keywords: cerebrospinal fluid leak; intracranial hypotension; lumbar puncture; post-LP headache; post-dural puncture headache.

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References

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