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Am Fam Physician. 2005;71(5):1008-1010

Although lumbar puncture is one of the most commonly performed invasive procedures in children and adolescents, little is known about the occurrence of subsequent headache and backache. Ebinger and colleagues performed a prospective study to determine the incidence of these after-effects.

Children two years and older undergoing diagnostic lumbar puncture were enrolled in the study. All children were instructed to maintain bed rest for 24 hours after the puncture. The incidence of backache and positional and nonpositional headache was recorded.

Of 112 patients undergoing lumbar puncture, 30 (27 percent) reported headaches after the procedure; 10 of these headaches were clearly positional. Positional headache was more common in children 10 years and older, occurring in 16 percent of children in this group compared with 5 percent of the younger children. Backache was reported by 45 patients (40 percent). Symptoms began within two days of the puncture and resolved within one week.

Headache and backache were more common in children 10 years and older than in younger children (82 versus 33 percent). Girls 10 years and older reported symptoms more frequently, but there was no gender difference in the younger group. Cerebrospinal fluid pleiocytosis was associated with a greater incidence of headache, but other factors such as multiple puncture attempts, needle size, and bevel position had no such association. After controlling for all factors, only age was associated with postpuncture headache or backache.

In this study, the incidence of positional and nonpositional headache after lumbar puncture was much lower than that reported in adults, about one third of whom have these symptoms. Backaches were common.

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