Parameters Related to Lumbar Puncture Do Not Affect the Occurrence of Post Dural Puncture Headache but May Influence its Clinical Phenotype

Abstract Background Post dural puncture headache (PDPH) is the most common complication of diagnostic and therapeutic lumbar puncture (LP). Objective The occurrence and clinical features of PDPH in relation to different demographic, clinical and paraclinical parameters and parameters related to LP was assessed. Methods The study was conducted as cohort prospective single-center study which included 252 consecutive patients (105 men and 147 women), average age of 47.3 ± 15.0 years, who had LP performed for different medical reasons between February 2018 and June 2018 at Clinic for Neurology Clinical Center of Serbia, Belgrade, Serbia. Results Among all of 252 patients PDPH was reported in 133 patients (52.8%). PDPH incidence was more frequently in women (64.7%, p = 0.043). Univariate analyses identified the following significant risk factors for PDPH occurrence: age (OR 1.74, 95% CI 1.05–2.89), female gender (OR 0.95, 95% CI 0.94–0.97), preexisting headaches (OR 0.91, 95% CI 0.88–0.95), duration of smoking (OR 2.40, 95% CI 1.39–4.17), diseases of circulatory system (OR 0.52, 95% CI 0.29–0.92), diseases of musculoskeletal system and connective tissues (OR 0.31, 95% CI 0.12–0.81). In the multivariable model, absence of preexisting headaches and duration of smoking remained independent risk factors of PDPH (OR   0.93, 95%CI 0.88-0.97, p  =  0.002, OR   4.23, 95% CI 1.27-14.08, p  =  0.019 respectively). For various characteristics of PDPH, significant risk factors are identified such as age, female, body mass index, existence of diseases of the circular or endocrine system as well as use of caffeinated drinks before LP, caliber of traumatic needle, direction and number of needle stitches during LP, occurrence, intensity and radiation of pain during LP, volume of sampled CSF, resting and hydration after LP and preexisting headache and earlier PDPH. All these models were well-calibrated (Hosmer-Lemeshow test p>0.05). Conclusion The results of this study are important for the prediction of the occurrence of PDPH, alleviation of its clinical phenotype in term of diferential diagnosis of headache after LP and the selection of effective pathogenetic therapy