Diagnostic criteria



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Table e-1; Diagnostic criteria for post-dural (post-lumbar) puncture headache (PDPH) as set by the Headache Classification Subcommittee of the International Headache Society3.

Diagnostic criteria

A.
B.

C.
D.

Headache that worsens within 15 minutes after sitting or standing, and improves within 15 minutes after lying, with at least one of the following (see 1 to 5) and fulfilling criteria C and D:
Dural puncture has been performed

Headache develops within 5 days after dural puncture

Headache resolves either*:


1. Neck stiffness

2. Tinnitus

3. Hypacusia

4. Photophobia

5. Nausea

1. Spontaneously within 1 week

2. Within 48 hours after effective

treatment of the spinal fluid leak

(usually by epidural blood patch).


* Note: in 95% of cases this is so. When headache persists, causation is in doubt.

Table e-2; Baseline characteristics of migraineurs (n=150) and healthy controls (n=49). P-values depicted in bold indicate significant differences (p<0.05), using independent-samples t-tests and χ2 tests appropriately. M = Migraine; LP = lumbar puncture; CSF = cerebrospinal fluid.

Variable

Total

(n=199)

Migraineurs

(n=150)

Controls

(n=49)

P

Age; mean (SD)

Female (%)

BMI
Education level (%)

Low

Middle


High
Comorbidity

None


Depressive

Epilepsy
Family History M.* (%)

Migraine subtype MO (%)
Intoxications

Alcohol (%)

Smoking (%)

Drugs (%)

Caffeine (%)
Hours sober; mean (SD)

LP effort; mean (SD)

Puncture traumatic (%)

CSF pressure; mean (SD)

PDPH (%)
Pain during LP

Stress prior to LP

Stress during LP

Headache immediately after LP


42.1 (14.1)

122 (61.3%)

24.2 (3.0)

17 (13.6%)

69 (34.6%)

94 (47.2%)

189 (95.0%)

6 (3.0%)

4 (2.0%)
108 (54.3%)

-

148 (74.4%)



37 (18.6%)

4 (2.0%)


188 (94.5%)
11.3 (2.3)

1.4 (1.0)

16 (8.0%)

17.7 (4.3)

64 (32.2%)
3.3 (2.4)

2.4 (2.7)

3.2 (2.8)

1.0 (1.6)


44.0 (13.3)

98 (65.3%)

24.3 (2.9)


140 (93.3%)

6 (4.0%)

4 (2.7%)
102 (68%)

66 (44%)

44 (29.3%)

24 (16.0%)

1 (0.7%)


142 (94.7%)
11.3 (2.1)

1.5 (1.1)


17.7 (4.5)

42 (28.0%)


3.3 (2.3)

2.4 (2.9)

3.2 (2.8)

1.0 (1.6)


36.3 (15.3)

24 (49.0%)

24.1 (3.3)


49 (100%)

-

-
6 (12.2%)



-

42 (85.7%)

13 (26.5%)

3 (6.1%)


46 (93.9%)
11.4 (2.8)

1.3 (0.8)


17.4 (3.8)

22 (44.8%)


3.2 (2.6)

2.1 (2.3)

3.2 (2.9)

1.0 (1.6)




0.001

0.041

0.746

0.179


<0.001

0.036

0.100


0.018

0.834
0.871

0.189
0.716

0.028

0.829


0.544

0.958


0.762


Figure e-1; Flowchart showing distribution of study subjects in relation to PDPH and selected treatment. AEBP = autologous epidural bloodpatch; Conservative = conservative treatment. *One female subject was excluded from the PDPH analysis due to headache symptoms that could be attributed to neither PDPD nor migraine, and were suggestive for chronification of migraine.



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