Cigarette Smokers Have Reduced Risk for PostDural Puncture Headache

Abstract

Background: Although headache is the most common complication of dural puncture, knowledge gaps remain about patient-related risks. Data are lacking on the role, if any, of tobacco smoking, race, anxiety, depression, and Post Traumatic Stress Disorder (PTSD) in conferring risk for post-dural puncture headache (PDPH). Objective: To determine the influence of tobacco smoking, race, anxiety, depressed mood, and PTSD on the risk for PDPH. Study Design: Retrospective chart review, single site. Methods: We determined the incidence of significant PDPH according to age, sex, race, smoking status, and psychiatric diagnosis in 153 consecutive research patients at the Cincinnati Veterans Affairs Medical Center who had continuous cerebrospinal fluid (CSF) sampling performed after using a largebore (17 gauge) Tuohy needle to place a 20-gauge polyamide catheter in the lumbar spinal canal. Results: Thirty-nine subjects (25.5%) had significant PDPH, defined as requiring an epidural blood patch for therapy (an average of 4 days post-procedure). Greater age was associated with a decreased risk of PDPH (P = 0.008); subjects over the age of 40 had the lowest incidence (15.7%). Women and men had a 31.4% and 23.7% incidence of PDPH, respectively; these were not significantly different (P = 0.38). Neither were rates of PDPH in Caucasians (28.0%) and AfricanAmericans (15.6%) significantly different (P = 0.18). Healthy controls had a higher incidence of PDPH than patients with PTSD (P = 0.032). Smokers had a lower incidence of PDPH than nonsmokers, 13.7% vs. 34.1% (P = 0.009). Limitations: This was not a prospective study, rather a retrospective chart review. Conclusion: Most notably, smokers had a considerably reduced rate of PDPH in comparison with non-smokers. This information could be a useful addition to the clinical assessment of relative risk for PDPH. Further research into the mechanisms by which tobacco smoking may inhibit PDPH, such as nicotine stimulation of dopamine neurotransmission or alterations in coagulation, appears warranted. Key words: Anxiety, cerebrospinal fluid (CSF), epidural blood patch, headache, lumbar puncture, pain, post-dural puncture headache, post-traumatic stress disorder (PTSD), race, tobacco, Tuohy needle

The Impact of Anxiety on Post - Dural Puncture Headache in Routine Neurology Practice

“…In our study, 73,3% of the patients with PDPH were women, but this difference was not statistically significant compared to subjects without a headache (group 2). No correlation between PDPH and BMI was found in our study, which is in agreement with some studies [9,11], but not with others [3,8]. In terms of the LP method, it has been shown that needle type, needle size, operator experience, and procedure technique might all be major factors in the development of PDPH.…”

“…Also, it was determined that patients with a history of chronic or recurrent headaches or a recent headache (within the last seven days) before an LP be more likely to report PDPH [8,10]. Interestingly, smokers had a lower incidence of PDPH than on-smokers [11].…”

“…The clinical diagnosis was also reported to be a predictive factor of PDPH. Healthy controls had a higher incidence of PDPH than patients with Alzheimer disease [18], or post-traumatic stress disorder (PTSD) [11]. Patients with anxiety and depression, but without PTSD had a higher, but the insignificant incidence of PDPH than those with PTSD [11].…”

“…Healthy controls had a higher incidence of PDPH than patients with Alzheimer disease [18], or post-traumatic stress disorder (PTSD) [11]. Patients with anxiety and depression, but without PTSD had a higher, but the insignificant incidence of PDPH than those with PTSD [11]. It was found that the fear of the procedure (the patients' anxiety before the procedure) does not predispose the occurrence of a post-up headache [10].…”