Lumbar puncture: bed rest does not reduce headache

Clinical bottom line (level 1a)

  1. Patients with a dural puncture who rest in bed compared with moving around as normal are not less likely to develop a headache.
  2. The effect of different positions when lying flat is unclear.
  3. The effect of fluid supplementation is unclear.
Sudlow and Warlow: Cochrane Library 2001; 2 : -
Expires June 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: undergoing dural puncture
  • Intervention: bed rest or supplementary fluids compared with no bed rest or no extra fluids
  • Outcome: post-dural puncture headache

Articles found in ?all lanauges using Cochrane Controlled Trials Register, Medline, Embase, to December 2000 (search terms: detailed in text ) and hand-searching reference lists of retrieved articles and review articles, and contacting authors.

Selection criteria: by 1 reviewer
Appraisal criteria: by 1 reviewer based on randomisation, allocation concealment, blinding, completeness of follow-up
Articles excluded if:
14 RCTs found
  • 11 involving 1723 patients assessing bed rest
  • 2 involving 126 patients assessing head-down tilting
  • 1 involving 100 patients assessing fluid supplementation

The evidence

strict bed rest v. usual rest
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
headache days 294/836
(35.2%)		 1.13
(0.92 to 1.39) 		-35
(NNT = 53 to infinity;
NNH = 13 to infinity)

head-down tilt v. lying flat
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
headache days 31/67
(46.3%)		 0.94
(0.46 to 1.91) 		65
(NNT = 6 to infinity;
NNH = 6 to infinity)

prone v. supine
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
headache days 12/37
(32.4%)		 1.59
(0.64 to 4.0) 		-9
(NNT = 11 to infinity;
NNH = 3 to infinity)

fluid supplementation v. usual fluids
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
postural headache weeks 18/50
(36.0%)		 1.0
(0.44 to 2.25) 		-
(NNT = 6 to infinity;
NNH = 5 to infinity)

Comments

  1. There were too few studies with too few patients to assess th effect of different positions when lying, or the effect of fluid supplementation.

Citation

  1. Sudlow C, and Warlow C: posture and fluids for preventing post-dural puncture headache. Cochrane Library 2001; 2 : -
Search Terms: dural and headache in Cochrane Library
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient dural puncture
Intervention or Exposure bed rest or supplemental fluids
Comparison usual care
Outcome headache