Lumbar puncture: posture had no clear effect on headache.

Clinical bottom line (level 1b-)

Patients requiring diagnostic lumbar puncture who had four hours of prone bed rest after the procedure had no clear difference in headache, than those who had half an hour head tilt followed by three and half hours of supine bed rest.

Handler et al: Journal of the Royal Society of Medicine 1982; 75: 404-407

Expires January 2003

The study

Single-blinded ?concealed randomised trial without intention-to-treat
Setting: outpatient neurology department, UK

50 patients (aged ?, 54% female) requiring diagnostic lumbar puncture
Control Group: (n = 25, 20 analysed): thirty minutes 30 ° head down tilt followed by three and a half hours supine bed rest after lumbar puncture
Experimental Group: (n = 25, 24 analysed): four hours prone bed rest after lumbar puncture

100% followed for 7 days A 18G needle was used

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
headache	7 days	7 (35.0%)	8 (33%)	5% (-117% to 58%)	1.7% (-26% to 30%)	60 (NNT = 3 to infinity; NNH = 4 to infinity)

Comments

The trial was too small to show any clear difference in post lumbar puncture headache between prone bed rest and head tilt plus supine bed rest.

Citation

Handler CE, Smith FR, Perkin GD, et al: Posture and lumbar puncture headache: a controlled trial in 50 patients. Journal of the Royal Society of Medicine 1982; 75: 404-407

Contributor: Clare Wotton & Bob Phillips, January 2000
Reviewer:

_{Clinical Question.}

_Patient	_{requiring diagnostic lumbar puncture}
_{Intervention or Exposure}	_{prone bed rest}
_Comparison	_{head tilt and supine bed rest}
_Outcome	_headache