According to the Headache Classification Committee of the International Headache Society, headache after lumbar puncture is defined as “bilateral headaches that develop within 7 days after an lumbar puncture and disappears within 14 days. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent position”. This definition helps to avoid confusion with migraine or simple headache after lumbar puncture.
The onset of headache after lumbar puncture is usually within 24–48 h after dural puncture, but contrary to the above definition, it could be delayed by up to 12 days, indicating that the time points in the definition are random.
Although the headache may rarely present immediately after dural puncture, its occurrence should alert the doctor to an alternate cause such as rise in intracranial pressure, with associated displacement of intracranial structures. The postural nature of the headache is very characteristic and the symptoms are usually self‐limited, but sometimes it may be severe enough to immobilise the patient. Headache after lumbar puncture is usually dull or throbbing in nature, and can start in the frontal or occipital region, which can later become generalised.
It is possible for the pain to radiate to the neck and shoulder area, and could be associated with neck stiffness. Head movements exacerbate the pain and any manoeuvres that increase intracerebral pressure, such as coughing, sneezing, straining or ocular compression, may also worsen the symptoms. Other associated symptoms include lower back pain, nausea, vomiting, vertigo and tinnitus and, rarely, diplopia due to cranial nerve palsy and even cortical blindness.
Headache usually resolves within a few days, but the longest reported headache after lumbar puncture lasted for 19 months.
The most recent test to see why my balance is getting worse was done two days ago at the hospital. Given conflicting information both prior to the procedure as well as afterwards, I looked up symptoms yesterday since I had a very stiff neck that wasn't responding to heat, muscle relaxer or any pain medication. The neurologist said to drink beverages with caffeine if I developed a headache even though I told him I barely tolerate the amount of caffeine in decaffeinated coffee and tea.
The lumbar puncture lasted less than 20 minutes, the doctor actually whistled while he worked. I stayed in my clothes and shoes, lying on a stretcher with the back of my blouse hiked up. The numbing agent didn't work so I squeezed the nurse's hand while trying to relax. The doctor showed me the four vials of spinal fluid which were clear, told me what he'd be testing for and asked what else I wanted tested. Seriously.
I muttered a few things but was distracted by the nurse who was trying in vain to find a good vein for blood work. She called another nurse and he was successful. I was instructed to sit up slowly, instantly feeling like I'd been given IV Tequila, everything and everybody moving, not in a good way. The nurse asked if I was okay and I said no. I guess they were eager for lunch or the next patient because she said she would get a wheelchair.
I had to sign some papers before she wheeled me out to the car and my son. Came home and laid flat as instructed, adding a bag of frozen corn on my bruised vein since they had no chemical ice packs and the nearest ice machine in the minor procedures suite was broken. Will not get the results for several days, half hoping they find something, half hoping if they do, it's treatable.