THERE is abundant clinical as well as theoretical evidence that headaches after lumbar puncture and myelography are due to traction on pain-sensitive intracranial tissues, such as meninges and cerebral blood vessels, because of lowered intracranial pressure caused by leakage of spinal fluid through the dural puncture site. The evidence for this mechanism rests on the relief of pain by release of traction through recumbency, the demonstration of an extra-arachnoid pool of spinal fluid when air encephalography or myelography are attempted after a previous lumbar puncture, cerebrospinal fluid leaks from the site of a previous lumbar puncture (observed at subsequent laminectomy) and data provided by scintigrams of the circulation of radioactive isotopes injected into the cerebrospinal subarachnoid space. Postlumbar puncture headache might be expected to occur more frequently following myelography, when the relatively large spinal needle (18-gauge) is left in situ for the duration of the study.
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Levine MC, White DW. Chronic Postmyelographic Headache: A Result of Persistent Epidural Cerebrospinal Fluid Fistula. JAMA. 1974;229(6):684–686. doi:10.1001/jama.1974.03230440042030
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