Increased Risk of Post-Dural Puncture Headache Associated With Lower Glucose Levels

Jin-sung Park, MD

Results from a retrospective cohort study of 969 patients who underwent diagnostic lumbar puncture following a standardized protocol revealed that low glucose levels were inversely associated with risk for post-dural puncture headache (PDPH).

Jin-sung Park, MD, senior author, and assistant professor, School of Medicine, Kyungpook National University, and colleagues found that after adjusting for other variables that could be related to PDPH, the development of PDPH was independently associated with age (odds ratio [OR], 0.97; 95% CI, 0.95—0.99; P = .001) and serum glucose levels (OR, 0.98; 95% CI, 0.97—0.99; P = .008).

Following classification by age, serum glucose levels were persistently lower in patients with PDPH versus those patients without PDPH in all age groups, with more significant differences observed in the elderly (age <30 years: 103.4 mg/dL vs 106.3 mg/dL, P = .716; >60 years: 111.8 mg/dL vs 137.3 mg/dL, P = .023).

Park and colleagues concluded, “A recent study divided PDPH into headaches that occurred immediately after PDPH and those headaches which occurred 24 hours or more after LP. Our study found that the collection of a larger volume of CSF (>30 mL) significantly increased the risk for immediate PDPH, but not for PDPH after 24 hours.”

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Of the 969 patients included in study, diagnostic lumbar puncture (LP) was used in 198 patients to evaluate neurodegenerative diseases such as dementia and cerebellar ataxia, and 174 patients to detect meningitis or encephalitis, the most among other reasons. The mean age among patients was 57 years (standard deviation [SD] +16.3 years) and 48 of the 969 cohort (5%; 95% CI, 3.7—6.5%) experienced PDPH.

Of the 48 patients with PDPH, 36 (75%) were improved with bed rest and conservative manage. The remaining 12 patients (25%) improved their headache with a single therapeutic epidural blood patch (EBP).

The average age of patients with PDPH was 47.7 years compared with 57.7 for those without PDPH. Additionally, there was a greater proportion of females in the PDPH group (62.5% vs 44.8%).

During LP, operators used a single size (22 gauge), Quinke needle, inserted into the L4-5 interspace parallel to the long axis of the spine, and reinserted the stylet prior to the removal of the needle. Park and colleagues noted in their discussion, “A needle gauge between 16 and 19 is associated with a PDPH incidence of 70%, 20G to 22G with 40%, and a needle gauge between 24 and 27 reduce the incidences to 5% to 12%.”

Among the CSF-associated laboratory findings, the low glucose level was the only significant association in the PDPH group. Serum glucose, hemoglobin A1c (HbA1c), BUN, WBC count and C-reactive protein levels were lower in the PDPH group.

Further research is warranted to assess the effectiveness of raising glucose levels in order to prevent the occurrence of PDPH. However, this approach may prove to be a simple and novel technique for the prevention and treatment of PDPH.

REFERENCE

Hwang J, Lim YH, Eun MY, et al. Lower glucose level associated with increased risk for post-dural puncture headache. Headache. Published online May 28, 2020. doi: 10.1111/head/13850.