To assess the incidence of post-dural puncture headache (PDPH) using 22-gauge atraumatic needle (Sprotte, 22GS) compared with using traumatic needle (Quincke, 22GQ).

Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of atraumatic needles to reduce the incidence, neurologists seem to keep using traumatic needles.   

This was a randomized, double-blind study conducted at Nordland Hospital, Norway. Adults (18-60 years) scheduled for a dLP were included. A headache history was obtained prior to inclusion, and subjects with chronic headache (≥ 15 days per month) excluded. The LP and the CSF acquisition were performed in accordance with highly standardized procedures. Subjects were followed up on day 2 and 7.ClinicalTrials.gov Identifier: NCT02384031

In total, 172 subjects were enrolled, randomized, and lumbar punctured. Among these, 21 were excluded due to wrong inclusion (n =10), failed LP (n=9), withdrawal (n=1) and missed follow-up (n=1). Among the remaining 151 subjects (mean age 40.7 ± 12.4 years), 76 had dLP using 22GQ and 74 had dLP using 22GS.  The incidence of PDPH among subjects punctured with 22GS (18%) was significantly lower (p = 0.004) than among the subjects punctured with 22GQ (39%). Subjects who developed PDPH had significantly lower body mass index (p = 0.012), but there was no significant difference related to age (p = 0.064), sex (p = 0.239), height (p = 0.857), premorbid episodic migraine (p = 0.829), opening pressure (p = 0.117), amount CSF removed (p = 0.205) or number of LP attempts before succeeding (p = 0,623).

The use of 22G atraumatic needle more than halves the risk of developing PDPH compared to the use of 22G traumatic needle in dLP. This study provides strong support to make a change in practice where traumatic needles are still in regular use.