Are CSF pressure factors related to the development of post-dural puncture headache?

Post-dural puncture headache (PDPH) is an unavoidable situation seen in considerable number of patients, but the mechanism responsible is still unclear. CSF pressures measured at the time of puncture change after CSF drainage. In the present study, we investigated relationships between CSF pressure-related factors and occurrence of PDPH. We prospectively enrolled 103 participants who underwent CSF studies for meningitis. Using a standardized protocol, CSF opening pressure (OP) and closing pressure (CP) were measured, and cerebrospinal elastance (ECS) and pressure-volume index (PVI) were investigated. Within 14 days after dural puncture, we confirmed PDPH. CP was significantly lower than OP (10.2±3.5 cmH2O vs. 16.3±4.7 cmH2O, p <0.001). Of the 103 participants, 100 (97.0%) had decreased CP and 16 (15.5%) had values below 6 cmH2O. Among the demographic factors, body weight was correlated with OP (r=0.27), CP (r=0.35), and PVI (r=0.20). Height was weakly correlated with CP (r=0.199) During the study period, 22 participants (21.34%) developed PDPH. None of the CSF pressure factors were significantly different between the PDPH and non-PDPH group and did not contributed to the development of PDPH. CSF pressure factors might not be related to the development of PDPH.