Post-Lumbar Puncture Headache Following Cerebrospinal Fluid Analysis

Case at a Glance

An 18-year-old female developed severe post-lumbar puncture headache following CSF collection, with symptoms persisting beyond the typical resolution timeframe despite standard management approaches.

Patient's Story

The patient, a petite 18-year-old female (53kg, 165cm), underwent lumbar puncture on July 11th with collection of 8ml cerebrospinal fluid for diagnostic purposes. She presented with a history of chronic headaches prior to the procedure. Three days post-procedure (July 14th), she developed an excruciating headache described as 'unimaginable' intensity, significantly worse than her baseline chronic headaches. The headache was interfering with her ability to study for upcoming examinations. Standard analgesics provided no relief, prompting her to seek urgent medical advice.

Initial Assessment

Post-lumbar puncture headache (PLPH) was suspected based on temporal relationship to the procedure and characteristic severe intensity. The patient's baseline chronic headache condition complicated the clinical picture. Physical examination would typically reveal orthostatic component to headache, though specific examination findings were not documented in initial presentation.

The Diagnostic Journey

The diagnosis of post-lumbar puncture headache was made based on clinical criteria: severe headache developing within 5 days of lumbar puncture, with onset 72 hours post-procedure. The volume of CSF collected (8ml) was within normal diagnostic range, though individual patient factors including low body weight and pre-existing headache disorder may have contributed to symptom severity.

Final Diagnosis

Post-lumbar puncture headache (PLPH) secondary to CSF leak, complicated by underlying chronic headache disorder

Treatment Plan

Initial conservative management including bed rest, increased fluid intake, and caffeine supplementation. Given failure of standard analgesics, consideration for epidural blood patch if symptoms persist beyond 48-72 hours. Symptomatic relief measures including dark environment, minimal activity, and stronger analgesics under medical supervision.

Outcome and Follow-up

Patient required ongoing monitoring for symptom resolution. Typical PLPH resolves within 1-2 weeks with conservative management, though epidural blood patch may be necessary for persistent cases. Follow-up scheduled to assess symptom progression and need for additional interventions, particularly given upcoming academic commitments and inadequate response to initial pain management.