Technique to Avoid Spinal-Tap Headache

To prevent cephalalgia after lumbar punctures certain precautions should be taken. A small needle (no. 18) should be used, and it should be inserted in such a way as to separate rather than cut the dural fibers, most of which run longitudinally. After the needle is removed the patient should be made to lie on his abdomen for three hours before ambulation. No. 18 needles were used and the dural fibers intentionally cut in a test group of 894 patients. They were plauced on their abdomens for three hours. Cephalalgia followed in four, an incidence of less than 0.5%. The same technique was followed in a contratest group of 200 patients except that for three hours after the puncture they were kept supine. The incidence of cephalalgia in this group was 36.5%. It is assumed that assumption of the prone position staggers the punctures in the dura and arachnoid, decreases the potential epidural space, and releases the tension on the dural and arachnoidal tears; this would reduce the loss of spinal fluid. Whatever the explanation, the results were convincing.