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CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review.

Publication ,  Journal Article
Smith, JH; Mac Grory, B; Butterfield, RJ; Khokhar, B; Falk, BL; Marks, LA
Published in: Headache
September 2019

OBJECTIVES: (1) To perform a systematic literature review to evaluate associations between post-dural puncture headache (PDPH) and opening pressure (OP), closing pressure (CP), and volume of cerebrospinal fluid (V) removed. (2) To perform a case-control study to evaluate pressure-volume index (PVI) as a novel risk factor for PDPH. BACKGROUND: According to the International Classification of Headache Diagnoses, 3rd Edition (ICHD-3), the diagnosis of PDPH requires documentation of intracranial hypotension. However, this remains an unproven concept. METHODS: A systematic literature review was conducted, searching Cochrane Database of Systematic Reviews, Ovid EMBASE, OVID MEDLINE, Scopus, and Web of Science. Study inclusion required a comparison of headache incidence following a LP as a function of OP, CP, and/or V. A retrospective, case-control study with 1:1 matching was conducted utilizing ICHD-3 criteria. Patients with factors that could influence CSF pressure were excluded. RESULTS: In our case-control study, we did not identify a paired difference in either median (95% CI) elastance (0.05 [-0.09, 0.11], P = .503) or PVI (4.53 [-7.98, 19.97], P = .678). We identified 22 references, evaluating V (n = 14), OP (n = 11), and/or CP (n = 4). There was no convincing evidence for an association of PDPH with either OP or CP. A minority of studies documenting an association with V included patients with high-volume CSF removal, and/or stratified patients by the timing of the headache onset. CONCLUSIONS: The overall risk of PDPH does not appear to be influenced by OP, CP, V or PVI. PDPH may be related to V in instances of high-volume removal, and depend on the timing of outcome assessment. Future revision of criteria should consider the existence of immediate and delayed PDPH subtypes, and not presume intracranial hypotension as a mandatory feature.

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Published In

Headache

DOI

EISSN

1526-4610

Publication Date

September 2019

Volume

59

Issue

8

Start / End Page

1324 / 1338

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Post-Dural Puncture Headache
  • Neurology & Neurosurgery
  • Humans
  • Cerebrospinal Fluid Pressure
  • Case-Control Studies
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Smith, J. H., Mac Grory, B., Butterfield, R. J., Khokhar, B., Falk, B. L., & Marks, L. A. (2019). CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review. Headache, 59(8), 1324–1338. https://doi.org/10.1111/head.13602
Smith, Jonathan H., Brian Mac Grory, Richard J. Butterfield, Babar Khokhar, Bryce L. Falk, and Lisa A. Marks. “CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review.Headache 59, no. 8 (September 2019): 1324–38. https://doi.org/10.1111/head.13602.
Smith JH, Mac Grory B, Butterfield RJ, Khokhar B, Falk BL, Marks LA. CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review. Headache. 2019 Sep;59(8):1324–38.
Smith, Jonathan H., et al. “CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review.Headache, vol. 59, no. 8, Sept. 2019, pp. 1324–38. Pubmed, doi:10.1111/head.13602.
Smith JH, Mac Grory B, Butterfield RJ, Khokhar B, Falk BL, Marks LA. CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review. Headache. 2019 Sep;59(8):1324–1338.
Journal cover image

Published In

Headache

DOI

EISSN

1526-4610

Publication Date

September 2019

Volume

59

Issue

8

Start / End Page

1324 / 1338

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Post-Dural Puncture Headache
  • Neurology & Neurosurgery
  • Humans
  • Cerebrospinal Fluid Pressure
  • Case-Control Studies
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1103 Clinical Sciences