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Caffeine in the prophylaxis of post lumbar puncture headache.

Three Part Question

Can [caffeine] be used in [in patients undergoing lumbar puncture] as [prophylaxis for headache]?

Clinical Scenario

You are preparing to perform a lumbar puncture to exclude subarachnoid haemorrhage. The patient is concerned that he might develop a worse headache after the lumbar puncture as his father has experienced in the past. He asks you if there is anything you could do to ensure this does not happen. You are using the smallest available LP needle, and you wonder whether prophylactic caffeine could prevent post lumbar puncture headache.

Search Strategy

Medline 1950ľApril week 1 2010, using the interface MESZ Ovid MEDLINE.
[(Caffeine*.ti, ab or exp Caffeine) AND (post-dural puncture headache/dt or exp Post-dural puncture headache or lumbar puncture.ti, ab or exp Spinal puncture)].

Search Outcome

Three hundred and seventy-five papers were found. All abstracts were reviewed and only two papers were selected as they address the three part question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Yucel A, Ozyalcin S et al
1994
Turkey
60 patients administered spinal anaesthesia for lower abdominal or lower extremity surgery. Patients received either 1000 ml of normal saline with 500 mg caffeine or 1000ml n/saline. during the first 90 min after spinal anaesthesia.Randomized, double-blind, placebo-controlled trial.A 10 cm visual analogue scale was used to assess headache severity every 4 h for 48 h and then daily until day 5.The incidence of moderate and severe headache was higher in the control group (11 of 30 = 37%) versus caffeine treatment (3 of 30 = 10 %) (P=0.03)There are no details on how randomisation or blinding was performed. The study recruited patients receiving spinal anaesthesia, not an LP
Esmaoglu A, Akpinar H et al
2005
Turkey
210 patients scheduled to have spinal anaesthesia for lower extremity surgery. 1 h before spinal anaesthesia patients received placebo, 500 mg paracetamol +75 mg caffeine or 500 mg paracetamol +125 mg caffeine. Same dose was repeated every 6 h for 3 dayProspective randomized, blinded, placebo-controlled trial.Patients were interviewed about symptoms of post dural puncture headache at days 1, 2, 3, 4 and 7.The rates of post dural headaches were 11 of 70 (15.7%), 10 of 70 (14.3%) and 10 of 70 (14.3%), respectively. There was no significant difference between the three groups. Unclear whether subjects were blinded to treatment allocation. The study recruited patients receiving spinal anaesthesia, not an LP

Comment(s)

No study has assessed caffeine in patients undergoing lumbar puncture.

Clinical Bottom Line

There is insufficient evidence to support the use of caffeine as an effective prophylactic treatment in lumbar puncture.

References

  1. Yucel A Intravenous administration of caffeine sodium benzoate for post dural puncture headache Regional Anesthesia Pain Medicine 1994;24:51-54.
  2. Esmaoglu A Oral multidose caffeine- paracetamol combination is not efectivefor the prophylaxis of postdural puncture headache J Clin Anesth 2005;17:58-61