Puncture headache

Blennow, K., Wallin, A., Hager, O. (1993). Low frequency of post-lumbar puncture headache in demented patients. Acta Neurol. Scand. 88, 221-223. 

Inadvertent injection into the subarachnoid space, occasionally causing cerebral or neurological problems, is a life-threatening complication of brachial plexus anesthesia. It can also cause postdural puncture headache (SEDA-21, 131). 

The accidental transformation of epidural to subarachnoid block can be dramatic, and tracheal intubation and ventilatory support may be necessary (102). Severe hypotension can result after inadvertent intrathecal local anesthesia (SEDA-21, 131). In women in labor, fetal bradycardia can occur. Postdural puncture headache can also be a sign of catheter migration. 

Postural headache is a common comphcation of spinal anesthesia (so-called postdural puncture headache). It is caused by CSF leakage through the puncture site. The incidence has been greatly reduced by the use of smaller-gauge and pencil-point spinal needles. However, headache (or psychosis) can be the presenting sign of subdural hematoma, which has twice been observed in women given spinal anesthesia for childbirth (SEDA-18,143). 

Another Vj receptor-mediated application is the use of desmopressin for primary nocturnal enuresis. Bedtime administration of desmopressin intranasal spray or tablets provides a high response rate that is sustained with long-term use, that is safe, and that accelerates the cure rate. Desmopressin also relieves post-lumbar puncture headache, probably by causing water retention and thereby facditating rapid fluid equilibration in the CNS. 

Sharma R, Panda A. Ondansetron-induced headache in a parturient mimicking postdural puncture headache. Can J Anaesth 2010 57 187-8. 

Aspirin is not often used for acute surgical pain due to its inhibition of platelet aggregation however, it may be prescribed after minor surgery either alone, or in combination with an opioid analgesic such as oxycodone (trade name Percodan"). A common dose would be 1-2 tabs PO Q4h as needed. The combination of butalbital (a mild barbiturate), caffeine, and aspirin (trade name FiorinoT ) is approved for use in nonvas-cular headache and has been used to treat postdural puncture headache. 

Fioricet and Fiorinal are indicated for the relief of the complex of symptoms known as tension headache. Fioricet is also widely employed for relief of postdural puncture headache (PDPHA), although it is not approved by the FDA for this indication. The mechanism of the drug effect is not completely understood. 

Daniels, A. M. and R. Sallie, Headache, Lumbar Puncture, and Expectation , The Lancet 1, no. 8227 (1981) 1003 Davanloo, H., Basic Principles and Techniques in Short-Term Depression, New York S. P. Medical 8C Scientific Books, 1976 Davies, D. L. and Michael Shepherd, Reserpine in the Treatment of Anxious and Depressed Patients , The Lancet 266, no. 6881 (1955) 117-20 Davies, Sharon, Potential Conflicts of Interest More Information from Jama , British Medical Journal (2009) http / / www.bmj.com/cgi/elet-ters / 338 / feb 05 i / b463... 

Viral meningitis refers to inflammation of the meninges. It is characterised by headache, neck stiffness and may be accompanied by fever. Lumbar puncture is required to differentiate between bacterial meningitis and viral meningitis. 

All patients with suspected SAH and a normal CT brain require lumbar puncture (van der Wee et al. 1995). The lumbar puncture should be delayed until at least 12 hours after the onset of the headache, unless CNS infection is suspected, to allow hemoglobin to degrade... 

Since CSF is in direct contact with the environment of the central nervous system (C NS), it is obvious that any changes in biochemical composition of brain parenchyma should be predominantly reflected in the CSF. A recent review by Reiber (2001) presents a complete concept of distinguishing diffusion of brain-derived proteins into CSF from diffusion of proteins from blood into CSF, allowing proteins that originate in the brain to be prioritized. Lumbar pimcture is an easy procedure, with a low incidence of complications. In a large study (Andreasen et al, 2001), only 4.1% of all patients experienced postlumbar headache, and an even smaller proportion of 2% was reported by Blennow et al. (1993). Thus, it is reasonable to postulate that lumbar puncture (LP) is a feasible and only moderately invasive procedure, and that CSF analysis could possibly improve current clinical and neuroimaging-based approaches to diagnosis. 

A 44-year-old Chinese man had severe occipital headache, nausea, and vomiting during acupuncture in the posterior neck. A CT scan showed hemorrhage in the third, fourth, and lateral ventricles, and blood was found in the lumbar fluid. The problem was due to puncture of a branch of the vertebral artery at the feng fu point, which coincides with the site for performing cisternal puncture. The patient made a spontaneous full recovery within 28 days. 

Sublethal effects of injected ricin have been documented in isolated case reports, and are difficult to distinguish from those of many other toxic or infectious agents. A 36 year old chemist who allegedly injected himself (i.m.) with an unknown amount of ricin prepared from homogenized castor seed, for example, complained of headache and rigors approximately 10 h later, then developed anorexia and nausea, a sinus tachycardia, erythematous areas around the puncture wounds, and local lymphadenopathy at the injection sites (Fine et al., 1992). 

A 10-year-old girl received erythromycin for a prolonged respiratory tract infection. She continued to have headaches and a stuff - nose a facial x-ray suggested maxillary sinusitis, which could not be confirmed following sinus puncture. Erythromycin was stopped and she was given amoxicillin (250 mg three times a day) for 10 days. 

Fig. S.12a,b. A 9-year-old boy with acute headache and initially misdiagnosed as meningitis. Lumbar puncture revealed SAH due to a ruptured cervical AVM...

Fig. 5.39a,b. Right MCA infarct in a patient who was administered with mild left sided hemiparesis. Doppler sonography revealed slightly increased velocity of the ICA and MCA and lumbar puncture showed hemosiderin. The patient did not report a typical sudden onset of headache. DSA revealed a small Pcom aneurysm but no visible vasospasms... 

Common side-effects in RFA are pain in the area of the puncture site, peritoneal irritation, nausea, vomiting, moderate fever, tiredness and headache. Fever, nausea, tiredness and vomiting are the main elements of post-ablation syndrome, which is seen in about two-thirds of patients and might last for several weeks. In general supportive therapy including mild analgesics and non-steroidals is sufficient in such cases (Ahrar et al. 2005 Rhim 2005 Konety 2006). 

A 12-year-old girl with a history of macrocephaly was initiated on minocycline for acne treatment. One week after she started taking minocycline, she presented with headaches, vision loss and nausea. She stopped the antibiotic after a 3-week course, but her headaches continued and progressed to bilateral vision loss. A lumbar puncture was done and she was found to have elevated intracranial pressure (ICP). The patient experienced a subsequent progressive loss of vision. She was treated with IV methylprednisolone and acetazolamide. The authors discuss other literature that supports the fact that elevated ICP can persist for 2-5 days after the drug is stopped. Patients need to be monitored closely and treated aggressively in order to prevent loss of vision [6 ]. 

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