Given the frequency of post lumbar puncture headaches(PLPH) observed in our neuro-ophthalmology clinic, we studied the incidence of PLPH in all the patients that underwent lumbar punctures between 2019-2022 in our tertiary health care center. We hypothesized that higher opening pressure(OP) was associated with higher chances of developing PLPH.

PLPH are a common complication of diagnostic lumbar puncture, usually believed to stem from cerebrospinal fluid(CSF) leakage causing intracranial hypotension. 

A retrospective review of adult patients who underwent lumbar punctures between 2019-2022 was conducted. Data included patient history and demographics, procedure details, incidence of PLPH, opening and closing pressures, and diagnoses. Interventions like blood patches were recorded. Statistical analysis used t tests and chi-square tests.

We recorded a total of 256 lumbar punctures in 220 patients: 31% males, 70% females; predominantly White (66.4%). Average age was 51.73 years (range: 20-93). The percentage of idiopathic intracranial hypertension (IIH) cases was 27.3%(70/256), with 45.7%(32/70) having PLPH.

PLPH incidence was 29% and significantly associated with higher OP (p<0.001), but not closing pressure (p=0.580) or volume removed (p=0.630). The incidence of PLPH in patients with IIH versus those without IIH (p<0.001) was significantly different. A history of headaches was significantly more prevalent in the PLPH group [53% vs. 15%(p<0.001)]. PLPH were not significantly associated with pressure difference (p=0.19) or needle gauge (p=0.490).

This retrospective study highlights OP as a key factor in the occurrence of PLPH, indicating it as a crucial factor, while closing pressure, CSF volume, and needle gauge were not deemed significant. Elevated OP is characteristically more prevalent in IIH, providing a probable explanation for the observed increased incidence of PLPH in IIH patients relative to other diagnoses. There is likely a notable correlation between IIH and PLPH, which advocates for more extensive research on PLPH within IIH patients to enhance patient care.