1 Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
2 Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
Cephalalgia. 2019 Feb;39(2):245-253. doi: 10.1177/0333102418782192. Epub 2018 Jun 17.
Headache is disabling and prevalent in idiopathic intracranial hypertension. Therapeutic lumbar punctures may be considered to manage headache. This study evaluated the acute effect of lumbar punctures on headache severity. Additionally, the effect of lumbar puncture pressure on post-lumbar puncture headache was evaluated.
Active idiopathic intracranial hypertension patients were prospectively recruited to a cohort study, lumbar puncture pressure and papilloedema grade were noted. Headache severity was recorded using a numeric rating scale (NRS) 0-10, pre-lumbar puncture and following lumbar puncture at 1, 4 and 6 hours and daily for 7 days.
Fifty two patients were recruited (mean lumbar puncture opening pressure 32 (28-37 cmCSF). At any point in the week post-lumbar puncture, headache severity improved in 71% (but a small reduction of -1.1 ± 2.6 numeric rating scale) and exacerbated in 64%, with 30% experiencing a severe exacerbation ≥ 4 numeric rating scale. Therapeutic lumbar punctures are typically considered in idiopathic intracranial hypertension patients with severe headaches (numeric rating scale ≥ 7). In this cohort, the likelihood of improvement was 92% (a modest reduction of headache pain by -3.0 ± 2.8 numeric rating scale, p = 0.012, day 7), while 33% deteriorated. Idiopathic intracranial hypertension patients with mild (numeric rating scale 1-3) or no headache (on the day of lumbar puncture, prior to lumbar puncture) had a high risk of post- lumbar puncture headache exacerbation (81% and 67% respectively). Importantly, there was no relationship between lumbar puncture opening pressure and headache response after lumbar puncture.
Following lumbar puncture, the majority of idiopathic intracranial hypertension patients experience some improvement, but the benefit is small and post-lumbar puncture headache exacerbation is common, and in some prolonged and severe. Lumbar puncture pressure does not influence the post-lumbar puncture headache.
头痛是特发性颅内高压症中常见且致残的症状。治疗性腰椎穿刺可能被用于管理头痛。本研究评估了腰椎穿刺对头痛严重程度的急性影响。此外，还评估了腰椎穿刺压力对腰椎穿刺后头痛的影响。
前瞻性招募特发性颅内高压症患者进行队列研究，记录腰椎穿刺压力和视乳头水肿分级。头痛严重程度使用数字评分量表（NRS）0-10 进行记录，在腰椎穿刺前、腰椎穿刺后 1、4 和 6 小时以及之后 7 天的每天记录。
共招募了 52 名患者（平均腰椎穿刺开放压力 32（28-37cmCSF））。在腰椎穿刺后的任何一周内，71%的患者头痛严重程度得到改善（但数字评分量表仅降低了-1.1±2.6），64%的患者头痛加重，30%的患者出现严重加重≥4 分。在特发性颅内高压症患者中，治疗性腰椎穿刺通常用于严重头痛（数字评分量表≥7）的患者。在本队列中，改善的可能性为 92%（头痛疼痛适度减轻-3.0±2.8 分，p=0.012，第 7 天），而恶化的可能性为 33%。头痛程度较轻（数字评分量表 1-3）或无头痛（在腰椎穿刺当天，腰椎穿刺前）的特发性颅内高压症患者腰椎穿刺后头痛加重的风险较高（分别为 81%和 67%）。重要的是，腰椎穿刺开放压力与腰椎穿刺后头痛反应之间没有关系。
腰椎穿刺后，大多数特发性颅内高压症患者的头痛有所改善，但获益较小，腰椎穿刺后头痛加重常见，有些患者头痛持续时间长且严重。腰椎穿刺压力不会影响腰椎穿刺后头痛。
