To the Editor Factors associated with post–lumbar puncture headache occurrence have been thoroughly highlighted by Monserrate et al.1 The use of a smaller-tipped needle can decrease the incidence of headache (the protocol used in the study1) provided that the number of punctures does not increase. Multiple punctures probably increase the incidence of headaches. If use of a smaller needle increases the number of punctures, the difference between small and large needles in producing headaches may be reduced. Therefore, the expertise of the person performing the puncture and the number of attempts are of importance; these seem to have been overlooked. Other important, yet missing, factors are pregnancy and needle bevel placement axis. The incidence of post–lumbar puncture headache increases with pregnancy, and it occurs less frequently when the needle bevel is placed parallel with the length of the neuraxis during insertion.2,3
Golzari SEJ, Mahmoodpoor A, Rikhtegar R. Factors Contributing to Post–Lumbar Puncture Headache. JAMA Neurol. 2015;72(7):834–835. doi:10.1001/jamaneurol.2015.0694
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