The importance of sex, age, needle size, height and body mass index in post-lumbar puncture headache

In this, prospective study 37% of 239 patients developed a post-lumbar punc ture headache (PPH) after a diagnostic lumbar puncture. PPH was more preval ent in females than males (46% vs. 21%; P = 0.0003) as were the severest fo rm of PPH (64% vs. 23%; P = 0.02) and nausea (74% vs. 39%; P = 0.01) in tho se who developed PPH. Females scored their pain in the upright position mor e severe on a 100-mm visual analogue scale than males (median 60 mm vs. 47. 5 mm; P = 0.02). The frequency of PPH was higher with the use of a 20-gauge compared with a 22-gauge needle in all patients (50% vs. 26%; P = 0.0002) and in females (57% vs. 36%; P = 0.02) and males (38% vs. 10%; P = 0.004), separately. Neither age, weight, height, nor body mass index (BMI), influen ced the prevalence of PPH, but tinnitus was more prevalent in tall compared with smaller patients (53% vs. 17%; P = 0.02). Old age was associated with a long median pain delay upon rising, and also, small patients tended to r eport a longer median pain delay than tall patients. The pain intensity cha nged more slowly upon rising and reclining in patients with a high BMI than in those with a lower BMI (median 60 s vs. 12 s; P = 0.02). The results co ncerning height, BMI and needle size might be anticipated according to the leakage theory. In a multivariate analysis sex (P = 0.0003) and needle size (P = 0.0002) were related to the development of PPH on a statistically sig nificant level. Furthermore, the pain severity was positively related to fe male sex (P = 0.03) and young age (P = 0.03). The pain delay increased with age (P = 0.008) and the pain decrease time increased with an increasing BM I (P = 0.04).