Arjona A
Consulta de Neurología, Hospital Cruz Roja Española, Córdoba, España.
Rev Neurol. 1998 Dec;27(160):1027-33.
In spite of the large number of authors who have studied headache following lumbar puncture and spontaneous intra-cranial hypotension, many aspects remain little known, and there is still no completely satisfactory non-invasive treatment.
In one group of patients there is an increased risk of post lumbar-puncture headache: adults between 20 and 50 years old, of low body weight and a previous history of chronic bilateral headache. In these patients all possible prophylactic measures should be taken whilst the lumbar puncture is being performed, so as to avoid the onset of headache. Use of modern atraumatic needles of small diameter and with a lateral opening have been shown by many studies to be satisfactory. There are also other manoevres which help to reduce the frequency of post lumbar-puncture headache, such as the insertion and withdrawal of the needle with the bevel parallel to the fibres of the dura mater and reinsertion of the stylet before withdrawing the needle. Once the patient has developed post lumbar-puncture headache, or spontaneous intracranial hypotension, initially treatment with cerebral vasoconstrictors such as oral caffeine may be used. After a period of time (2-4 weeks) which makes spontaneous regression of the headache unlikely, the treatment of choice involves epidural patches.
Well-designed studies are necessary to demonstrate the efficacy of oral caffeine (and other drugs) in post lumbar-puncture headache.
尽管有大量作者研究了腰椎穿刺后头痛和自发性颅内低压，但许多方面仍鲜为人知，且目前仍没有完全令人满意的非侵入性治疗方法。
在一组患者中，腰椎穿刺后头痛的风险增加：年龄在20至50岁之间、体重较轻且有慢性双侧头痛病史的成年人。对于这些患者，在进行腰椎穿刺时应采取所有可能的预防措施，以避免头痛发作。许多研究表明，使用现代小直径、带侧孔的无创伤针是令人满意的。还有其他一些操作有助于降低腰椎穿刺后头痛的发生率，例如在进针和退针时使针斜面与硬脊膜纤维平行，以及在拔针前重新插入针芯。一旦患者出现腰椎穿刺后头痛或自发性颅内低压，最初可使用脑血管收缩剂如口服咖啡因进行治疗。经过一段时间（2至4周），头痛不太可能自发缓解后，首选的治疗方法是硬膜外填充。
需要精心设计的研究来证明口服咖啡因（及其他药物）对腰椎穿刺后头痛的疗效。
