ORIGINAL ARTICLE Post-lumbar puncture headache: an adverse effect in multiple sclerosis work-up Domizia Vecchio 1 & Paola Naldi 1 & Veronica Ferro 1 & Cristoforo Comi 1 & Maurizio Angelo Leone 2 & Roberto Cantello 1 Received: 9 November 2018 /Accepted: 14 January 2019 # Fondazione Società Italiana di Neurologia 2019 Abstract Background Lumbar puncture (LP) is a safe procedure commonly performed in the diagnostic work-up of multiple sclerosis (MS), and its main adverse event is post-LP headache (PLPH). Predictors for PLPH in MS are not established. Aims To describe the occurrence of, and, factors related to PLPH in patients with suspected MS, studied on a daily-basis admission. Patients and methods One hundred patients (70 females) were admitted for a diagnostic LP (standardized with a traumatic 19-G needle), observed for 6 h, and evaluated for adverse events 2 and 7 days later. Descriptive statistics and a multivariate analysis (for PLPH) were performed. Results Fifty-seven (57%) patients had PLPH at 48 h, which persisted 1 week in 31, and only two presented beyond the first 2 days. Other adverse events were tinnitus and neck stiffness. None required investigations or was hospitalized. Age was the only predictor for PLPH at day 2, whereas the onset of headache within 48 h and female gender were predictors for PLPH at day 7. Conclusion PLPH is a frequent complication of LP performed on daily-basis admission in MS work-up. The maximum onset is within the first 48 h. Age and gender seem the only predictors for the appearance and persistence of PLPH. Keywords Diagnostic work up . Headache . Lumbar puncture . Multiple sclerosis Introduction Post-lumbar puncture headache (PLPH) is a common ad- verse event occurring within 7 days after a spinal tap, and usually resolving in 14 days. By definition, PLPH Bworsens within 15 minutes of standing and disappears within 30 minutes of the lying position^ [1]. The drainage of 10% of the total cerebrospinal fluid (CSF) volume could cause an orthostatic bilateral headache in about one third of patients [2]. Pain is generally located to the frontal and occipital regions and is worsened by maneu- vers increasing the intracranial pressure (i.e., coughing, sneezing). Other adverse events occurring after a spinal tap are lumbar pain, nausea, vomiting, dizziness, and tin- nitus, which may associate with headache [3]. PLPH is a clinical diagnosis, and several predictors, mostly related to the procedure itself, have been proposed. The use of atraumatic, compared to traumatic, needles, and indepen- dently from their sizes, have been related to a lower risk of PLPH [4], whereas no differences in the occurrence of back pain, severe PLPH, or other types of headache have been described between the two needles [4]. Anyway, most studies were performed in different clinical settings, and included heterogeneous groups of participants under- going dural taps not only for diagnosis, but also for anes- thesia or myelography [5]. Of note, bed rest after the tap was not associated with PLPH prevention [5]. On the other hand, looking at patients’ features, data on predic- tors for PLPH are less established. PLPH was reported to be more frequent in females, in patients at a younger age, and with a low body mass index [6]. Our first aim was to describe the incidence and features of PLPH in the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-019-3724-z) contains supplementary material, which is available to authorized users. * Domizia Vecchio domizia.vecchio@gmail.com 1 Neurology Unit, Department of Translational Medicine, AOU Maggiore della Carità and University of Piemonte Orientale, Novara, Italy 2 Neurology Unit, Department of Medical Sciences, IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy Neurological Sciences https://doi.org/10.1007/s10072-019-3724-z