SPINAL HEADACHES AFTER MYELOGRAMS - COMPARISON OF NEEDLE TYPES

OBJECTIVE. We compared traditional bevel-tip end-hole spinal needles a nd pencil-point-tip side-hole needles for the incidence, severity, and duration of spinal headaches in subjects who had myelograms. Age, sex , and myelographic findings were examined. SUBJECTS AND METHODS. We st udied 138 subjects referred for myelograms. For 108 procedures, we ran domly used 22-gauge Quinke bevel-tip end-hole needles or 22-gauge Spro tte pencil-point-tip needles. The 30 additional subjects were examined with Gertie Marx pencil-point-tip needles. All myelograms were perfor med by one of two neuroradiologists using recommended doses of iohexol . The myelograms were examined by an independent neuroradiologist for quality of image and presence of extraarachnoid contrast material. Fiv e to 14 days after myelography, subjects were telephoned by an indepen dent observer and asked about the presence, severity, duration, and po sitional quality of headache. Spinal headache is defined by positional quality and increases in severity when the subject moves from horizon tal to sitting or standing. RESULTS. We found that four (8%) of 52 sub jects who had myelograms with Sprotte needles had spinal headaches. Li kewise, 14 (25%) of 56 subjects who had myelograms with Quinke needles had spinal headaches. We calculated a statistically significant diffe rence in the incidence of spinal headaches using chi-square analysis ( p = .02). The average grade and duration of the spinal headaches did n ot differ significantly, although they were less marked in the Sprotte group. Spinal headaches occurred more frequently in young and middle- aged subjects than in older subjects. We found one definite extraarach noid injection in each group. For the Gertie Marx needles, two (7%) of 30 subjects had spinal headaches. The average grade of postmyelogram headache was 2.5, and the mean duration was 1 day. There were no mixed injections. CONCLUSION. We found a significant reduction in spinal he adaches after myelograms when we used the pencil-point-tip side-hole n eedle. These results support the routine use of these needles for myel ography in young and middle-aged patients.