Factors Predisposing to Post Dural Puncture Headache in Children

Abstract

Background: Knowledge of the factors that predispose to postdural puncture headache in children may help reduce the occurrence of this complication. Materials and Methods: A retrospective cohort study of children who presented to the study institution between 2010 and 2018 was conducted. Children were divided into 2 groups: those who experienced postdural puncture headache and those who did not. The 2 groups were compared with respect to certain demographic, technical, and personnel-related factors. Only children who had opening pressure documented during the procedure were included in the core study group. Results: In univariate analysis, children aged ≥10 years, female gender, children with higher body mass index, standard blinded lumbar puncture procedure, use of sedation, higher opening pressure, and presence of pseudotumor cerebri increased the probability of postdural puncture headache. In multivariable logistic regression analysis, presence of pseudotumor cerebri was the only factor that attained statistical significance when the opening pressure was measured and documented. Conclusions: The risk factors for postdural puncture headache in a pediatric cohort varied from risk factors that are classically implicated in adults.

Opening Pressure and Post–Lumbar Puncture Headache in Children Undergoing Intrathecal Baclofen Trial

“…The rate of post-lumbar puncture headache in our population was higher than most other pediatric series (5%-12%). [2][3][4][5][6] However, if children in our study with elevated opening pressure were excluded, the post-lumbar puncture headache rate is 10%, which is similar to the literature, suggesting that the excess risk may be due, in part, to higher rates of elevated intracranial pressure in this population. We did not find patient or operative factors that predicted a post-lumbar puncture headache.…”

“…Although a lumbar puncture is a relatively safe procedure, post-lumbar puncture headache is a common complication, reported in 10% to 40% of adults and 5% to 12% of children. [1][2][3][4][5][6] The pathophysiology of post-lumbar puncture headache is not entirely understood; however, theories suggest that it may be due to a slow cerebrospinal fluid leak leading to relative intracranial hypotension and irritation of pain-sensitive fibers. 7 Patients typically present with a positional headache accompanied by nausea and vomiting with onset 48-72 hours after lumbar puncture.…”

“…In the pediatric literature, risk factors for the development of post-lumbar puncture headache include elevated opening pressure, use of sedation, female sex, higher body mass index, and older age (>10 years). 2 The risks of lumbar puncture in children with severe hyperkinetic or hypertonic motor disabilities are not well understood. The purpose of this study is to determine the frequency and predictors of post-lumbar puncture headache in children undergoing intrathecal baclofen trial.…”

Sphenopalatine ganglion blocks for post‐dural puncture headache: A case report in a 3‐year‐old child

“…Post‐dural puncture headache (PDPH) may occur after lumbar puncture (LP) or unintentional dural puncture (UDP) during epidural insertion. It is thought to be uncommon in children, but the true incidence is difficult to ascertain 1 . We report successful management of PDPH with bilateral sphenopalatine blocks (SPGB) in a young child.…”

“…It is thought to be uncommon in children, but the true incidence is difficult to ascertain. 1 We report successful management of PDPH with bilateral sphenopalatine blocks (SPGB) in a young child.…”