Abstract
Lumbar puncture is a diagnostic procedure commonly performed by emergency physicians.
Post-dural puncture headaches occur frequently after this procedure and can be associated
with significant morbidity and, occasionally, even death. There is also a lot of variation
in how post-dural puncture headaches are treated once they occur. This article seeks
to examine the science behind post-dural puncture headaches, their prevention and
treatment.
Keywords
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Article info
Publication history
Published online: September 18, 2007
Accepted:
October 2,
2006
Received in revised form:
May 25,
2006
Received:
August 1,
2005
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Lumbar Puncture and Post-Dural Puncture HeadachesJournal of Emergency MedicineVol. 39Issue 5