Spinal (post-LP) Headache
                        =========================

þ Caffeine for Spinal Headache:
 - 500 mg/500 cc NS over 1 hour.

þ Spinal Headache Background
 - incidence:  10-40%
 - typically occur 24-72 hours after procedure.
 - caused by CSF leak.

þ Causes of Spinal Headache:
 - larger needles cause more headaches [Kovanen J, Sukava R.  Duration of
   postural headache after lumbar puncture:  effect of needle size.  Headache
   1986;26(5):224 et seq.].  23 ga. is better than 22 ga. is better than 20
   ga.
 - multiple attempts don't seem to make headache more likely (no hole in the
   dura if you miss)
 - positioning ("lie flat for X hours") has no effect to prevent post-LP
   headache [Carbatt et al.  Lancet 1981;2(8256):1133 et seq.:  42% in those
   with bedres, 40% in those without].  Early ambulation may actually help
   prevent headache [Vilming.  Cephalgia 1988;8(2):75.].  More studies and
   abstracts to support this:
   <spinalh2.txt>
 - no correlation with sex, diagnosis, experience of LPer, amount of CSF
   removed, opening and closing pressures, CSF results, or post-procedure
   positioning.  Risks:  female gender, young age, pre-existing headache, lean
   body mass.  [Kuntz KM, et al. Post-lumbar puncture headaches: experience in
   501 consecutive procedures.  Neurology 1992;42(10):1884 et seq.]
 - Blood patch works very well [Crawford J.  Experience with epidural blood
   patch.  Anestheseia 1980;35:513 et seq.], and drugs and IVs don't help
   except that caffeine may help [Ford et al.  JEM 1989;7(1):1863 et seq.].