Abstract
BackgroundHeadache is disabling and prevalent in idiopathic intracranial hypertension. Therapeutic lumbar punctures may be considered to manage headache. This study evaluated the acute effect of lumbar punctures on headache severity. Additionally, the effect of lumbar puncture pressure on post-lumbar puncture headache was evaluated.MethodsActive idiopathic intracranial hypertension patients were prospectively recruited to a cohort study, lumbar puncture pressure and papilloedema grade were noted. Headache severity was recorded using a numeric rating scale (NRS) 0–10, pre-lumbar puncture and following lumbar puncture at 1, 4 and 6 hours and daily for 7 days.ResultsFifty two patients were recruited (mean lumbar puncture opening pressure 32 (28–37 cmCSF). At any point in the week post-lumbar puncture, headache severity improved in 71% (but a small reduction of −1.1 ± 2.6 numeric rating scale) and exacerbated in 64%, with 30% experiencing a severe exacerbation ≥ 4 numeric rating scale. Therapeutic lumbar punctures are typically considered in idiopathic intracranial hypertension patients with severe headaches (numeric rating scale ≥ 7). In this cohort, the likelihood of improvement was 92% (a modest reduction of headache pain by −3.0 ± 2.8 numeric rating scale, p = 0.012, day 7), while 33% deteriorated. Idiopathic intracranial hypertension patients with mild (numeric rating scale 1–3) or no headache (on the day of lumbar puncture, prior to lumbar puncture) had a high risk of post- lumbar puncture headache exacerbation (81% and 67% respectively). Importantly, there was no relationship between lumbar puncture opening pressure and headache response after lumbar puncture.ConclusionFollowing lumbar puncture, the majority of idiopathic intracranial hypertension patients experience some improvement, but the benefit is small and post-lumbar puncture headache exacerbation is common, and in some prolonged and severe. Lumbar puncture pressure does not influence the post-lumbar puncture headache.
Highlights
Headache is disabling and prevalent in idiopathic intracranial hypertension
This study aimed to evaluate the temporal change in headache severity in the week following a standardised Lumbar punctures (LPs), in patients with active intracranial hypertension (IIH)
Based on phenotypic characteristics using the International Headache Society ICHD-3 beta classification, we noted: Migraine-like or probable migraine-like (n 1⁄4 53, 80%), headache attributed to IIH (n 1⁄4 23, 35%), tension-type headache-like (n 1⁄4 5, 8%), other (n 1⁄4 5, 8%) and not classifiable (n 1⁄4 7, 11%) (Table 1)
Summary
Headache is disabling and prevalent in idiopathic intracranial hypertension. Therapeutic lumbar punctures may be considered to manage headache. At any point in the week post-lumbar puncture, headache severity improved in 71% (but a small reduction of À1.1 Æ 2.6 numeric rating scale) and exacerbated in 64%, with 30% experiencing a severe exacerbation ! Therapeutic lumbar punctures are typically considered in idiopathic intracranial hypertension patients with severe headaches Idiopathic intracranial hypertension patients with mild (numeric rating scale 1–3) or no headache (on the day of lumbar puncture, prior to lumbar puncture) had a high risk of post- lumbar puncture headache exacerbation (81% and 67% respectively). Conclusion: Following lumbar puncture, the majority of idiopathic intracranial hypertension patients experience some improvement, but the benefit is small and post-lumbar puncture headache exacerbation is common, and in some prolonged and severe. The risk of headache exacerbation post-LP has not been previously characterised in IIH
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