Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Neurology. 2013 Mar 5;80(10):941-8. doi: 10.1212/WNL.0b013e3182840bf6. Epub 2013 Feb 6.
To prospectively assess 1) the incidence and duration of postdural puncture headache (PDPH) in migraineurs and healthy subjects; 2) the associated risk factors; and 3) the risk of getting a migraine attack shortly before or after lumbar puncture (LP).
As part of an extensive biochemical migraine research program, we assessed the occurrence, duration, and characteristics of PDPH in 160 migraineurs and 53 age- and sex-matched healthy controls. In addition, we evaluated potential risk factors for PDPH as well as the risk of developing a migraine attack before or after LP.
In total, 64 of 199 subjects (32.2%) developed PDPH. Young age, low body mass index, severe headache immediately after LP, and sitting sampling position, but not being a migraineur, increased the risk of PDPH (all p < 0.05). Duration of PDPH was prolonged by history of depression, sitting sampling position, high perceived stress during the LP procedure, and multiple LP efforts (all p < 0.05). Migraine attacks were less likely to occur before or shortly after LP.
Migraineurs are not at increased risk of developing PDPH. PDPH duration is similar in migraineurs and age- and sex-matched controls. LP does not trigger migraine attacks, and the stress of an upcoming LP might even have a protective effect against onset of migraine attacks.
前瞻性评估 1）偏头痛患者和健康受试者硬膜穿刺后头痛（PDPH）的发生率和持续时间；2）相关的危险因素；3）腰椎穿刺（LP）前后发生偏头痛发作的风险。
作为广泛的生化偏头痛研究计划的一部分，我们评估了 160 例偏头痛患者和 53 名年龄和性别匹配的健康对照者中 PDPH 的发生、持续时间和特征。此外，我们评估了 PDPH 的潜在危险因素以及 LP 前后发生偏头痛发作的风险。
总共 199 名受试者中有 64 名（32.2%）出现 PDPH。年轻、低体重指数、LP 后立即出现严重头痛以及坐姿采样体位，但偏头痛患者除外，这些因素增加了 PDPH 的风险（均 p < 0.05）。抑郁史、坐姿采样体位、LP 过程中感知到的高压力以及多次 LP 尝试都会延长 PDPH 的持续时间（均 p < 0.05）。LP 前后偏头痛发作的可能性较小。
偏头痛患者发生 PDPH 的风险并不增加。PDPH 的持续时间在偏头痛患者和年龄及性别匹配的对照组中相似。LP 不会引发偏头痛发作，而即将进行 LP 带来的压力甚至可能对偏头痛发作起到保护作用。
