The time course of post-lumbar puncture headache.

According to the leakage theory, the time taken for pain to develop upon rising to the upright position will increase during the time course of post-lumbar puncture headache (PPH) as a consequence of the decreasing size of the healing dural rent, and the pain will decline. The aim of the present prospective study was to test this hypothesis, and to describe the temporal course of time and pain variables in PPH. The study showed that the course was fairly stable for all variables except on the first day, the second last day, and the last day. In the recumbent position, the headache was more severe on the first day (p<0.05) and milder on the last day (p<0.001) compared with the interim days; maximal headache in the upright position was milder on the second last (p<0.005) and last days (p<0.0001). Compared with the interim days, the time prior to increase of pain upon rising was shorter on the first day (p<0.05) and longer on the last day (p<0.001), and from start of increase until maximum was longer on the last day (p<0.01). The time to pain relief upon lying down did not vary significantly throughout the PPH period. The mobility of the patient as expressed by the PPH grade was fairly stable throughout the course of PPH until it increased in the last 2 days. The results are in good accord with the leakage theory.