Lumbar Puncture: bed rest did not clearly reduce incidence of headache

Clinical bottom line (level 1b-)

  1. In patients undergoing diagnostic lumbar puncture, mobilising instead of 4hrs bed rest may not affect incidence of headache (NNH = 81 at 7 days)
Spriggs et al: Postgraduate Medical Journal 1992; 68: 581-583
Expires January 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: neurology ward, UK

110 patients (aged 49y (SD 16y), 58% female) diagnostic lumbar puncture

Excluded if
  • pre-existing headache


    • Control Group: (n = 56, 52 analysed): supine bed rest for 4 hours
    Experimental Group: (n = 54, 50 analysed): mobilising after puncture

    93% followed for 7 days
    Outcome notes:
    • post-lumbar puncture headache : (headache lasting >2 hours moderate/severe and improved by lying down)

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    post-lumbar puncture headache 7 days 16
    (30.8%)    		 16
    (32%)    		 -4%
    (- 85% to 41%)    		 -1.23%
    (-19.3% to 16.8%)    		 81
    (NNT = 5 to infinity;
    NNH = 6 to infinity)

    Comments

    1. This study is too small to demonstrate a clear difference.

    Citation

    1. Spriggs DA, Burn DJ, French J, et al: Is bed rest useful after diagnostic lumbar puncture?. Postgraduate Medical Journal 1992; 68: 581-583
    Contributor: Bob Phillips and Musab Hayatli, February 2000
    Reviewer:

    Clinical Question.
    Patient undergoing lumbar puncture; LP
    Intervention or Exposure bed rest
    Outcome headache; PLPH