Factors associated with post-dural puncture headache: A single-center retrospective review

Abstract

Objective

Post-dural puncture headache (PDPH) is potential complication after procedures with dural puncture. This study analyzes how patient and procedural factors are related to the development of PDPH.

Methods

Demographic and procedural data were extracted from the electronic medical record in patients undergoing a dural puncture procedure from 1/1/2020 to 12/31/2020. Procedural variables were extracted from procedure reports including spinal level, number of punctures, any reported complications, needle type, and gauge. Fisher-exact test, with a subgroup analysis, and multivariable logistic regression were used to analyze the association of variables with the development of a PDPH.

Results

A total of 1237 procedures with 1005 patients were identified. The mean age was 56.9 ± 16.4 years, mean BMI was 31.0 ± 7.8 kg/m², and 534 (53.1%) identified as female. Seventy-four (7.3%) patients developed a PDPH with mean onset of 1.9 ± 1.9 days post-procedure. The likelihood of PDPH was significantly positively associated with both patient characteristics such as female sex (OR = 2.657, 95%CI [1.529,4.617], p < .001), BMI above 25 kg/m² (OR = 2.609, 95%CI [1.177,5.786], p = .015), and history of chronic tension headaches (OR = 2.943, 95%CI [1.688,5.130], p < .0003), as well as procedural characteristics such as decreasing gauge (OR = 1.124, 95%CI [1.111,1.136], p < .0001), higher opening pressure (mean difference = −6.288 ± 2.119. p = .005).

Conclusions

This retrospective study of fluoroscopy-guided dural puncture procedures shows that the incidence of PDPH is associated with several patient and procedural characteristics.