[##-year-old male/female] with headache with history and exam consistent with likely post-lumbar puncture (LP) headache (also known as a postdural puncture headache).
Initial consideration in this patient included post-LP headache, tension headache, migraine, cluster headache, meningitis, encephalitis, and intracranial hemorrhage or tumor among others.
Patient presented with report of headache that is worsened with upright position and improved with lying supine within [24-48] hours of having undergone LP. Patient noted to have a normal neurologic exam without report of any other preceding trauma. Treatment initiated in the ED with [oral/intravenous] caffeine with [minimal/significant/no] improvement. We discussed therapeutic blood patch with anesthesia and the patient, and after discussion of risks, benefits and alternatives the patient was [transferred to anesthesia/treated in the ED] with [significant improvement/resolution of headache].
Patient reported onset of headache was gradual, with no report of headache that was maximal at onset or thunderclap in nature. Doubt subarachnoid hemorrhage at this time. No fever, evidence of meningismus, or systemic infectious symptoms suggestive of meningitis or encephalitis at this time.
Patient reported onset of headache was gradual, with no report of headache that was maximal at onset or thunderclap in nature. Doubt subarachnoid hemorrhage at this time. No fever, evidence of meningismus, or systemic infectious symptoms suggestive of meningitis or encephalitis at this time.
Prior to discharge, we discussed return precautions, specifically for evidence of worsening headache or neurologic deficits, symptomatic treatment, and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient demonstrated understanding and agreement.
https://rebelem.com/post-lumbar-puncture-headaches/
https://rebelem.com/post-lumbar-puncture-headaches/
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