A new protocol reduces headache after lumbar puncture

Researchers of the Barcelonaβeta Brain Research Center (BBRC)research center of the Pasqual Maragall Foundationalong with the Sea Hospital and its research center (HMRIB), have published in Nature Scientific Reports the results of a standardized protocol for reduce and control headachethe most common complication after a lumbar puncture.

The lumbar puncture It is a key test in neurology because it allows obtain cerebrospinal fluid (CSF)an especially valuable sample in the context of the neurodegenerative diseases to analyze biomarkers relevant to brain health and, in particular, to research and clinical practice.

In Alzheimer’s research, CSF biomarkers are essential to better understand the disease in very early stageseven before symptoms appear, and to promote prevention strategies and the development of treatments. In this context, the research team has evaluated a protocol that reduces one of the most common side effects of lumbar puncture: headachea type of headache that can appear temporarily after performing a lumbar puncture.

“The lumbar puncture is an essential test to advance the study of Alzheimer’s biomarkers in CSF, and minimizing the discomfort of this test is key. Standardizing each step, from hydration to the type of needle and rest, allows us helps reduce headaches and make the procedure more bearable, especially when larger volume extractions are needed,” explains the Dr. Oriol Grauleader of the Clinical Research Group and Risk Factors for Neurodegenerative Diseases at the BBRC and co-author of the study.

The key contribution of ALFA cohort volunteers

The work has been carried out with cognitively healthy people from the ALFA cohort, promoted by the ”la Caixa” Foundationand it has been possible thanks to the participation and commitment of people who, voluntarily, make preventive research in Alzheimer’s viable.

The study analyzed the 1,147 lumbar punctures performed on 724 participants in the ALFA study, following a standardized protocol that combines: controlled hydration (500 ml of 0.9% saline intravenously), use of a 22G atraumatic pencil point needle, extraction of 13.5–15 ml of CSF without negative pressure, and 45 minutes of supervised rest after the procedure.

The results show that, with this protocol, headache after this test was 9.6% at 24 hours and 4.7% at 7 days. In people who did have headache, it was almost always mild (95.5% of cases at 24 hours; 87% at 7 days) and there were no serious cases or complications that required a blood patch (a procedure in which the patient’s own blood is injected to seal a possible cerebrospinal fluid leak) or hospitalization.

“The application of a standardized protocol has made it possible to reduce serious complications after the extraction of cerebrospinal fluid by lumbar puncture to 0,” adds the Dr. Antonio Montes, head of the Pain Unit at Hospital del Mar and researcher at its research institute and corresponding author of the study.

Since this is an observational study and does not include a control group, the researchers contextualize the improvement of this protocol by comparing its results with the existing literature. Specifically, when reviewing three similar studies, 24-hour post-puncture headache rates of 24.8%, 11.9% and 9% were described; Furthermore, more severe events such as hospitalization (2.5%) or the need for a blood patch (1.4%) are reported in these studies, while this type of complications were not recorded in this study.

The exploratory analysis also observed that, at 24 hours, Headache was more common in people with a history of chronic painwith a low or very high body mass index, and when the puncture was performed at lower lumbar levels.

“In addition to safety, it is very important to us that our participants’ experience is the best possible. A clear and reproducible protocol facilitates clinical practice, improves follow-up and helps ensure that, if a headache occurs, it is easily managed with common measures and without complications,” he explains. Anna Soteras, Director of the BBRC Clinical Operations Platform and co-author of the study.

The study stands out for its large sample size, the systematic application of a homogeneous protocol and a structured follow-up at 24 hours and 7 days. However, the authors point out that the absence of a control group and the fact that it was carried out in a very specific context, with a relatively limited age sample, may limit the generalization of the results to other environments and populations.

Improving the tolerability of lumbar puncture is not a minor detail: it is a key condition to continue advancing in preventive research. Having more standardized protocols with fewer complications helps reduce fear and makes it easier for more people to agree to undergo this test with confidence. This is especially relevant because cerebrospinal fluid provides fundamental information on Alzheimer’s biomarkers and allows for earlier and better answers to scientific questions that, over time, can translate into more precise diagnoses and more effective prevention strategies.