LUMBAR PUNCTURE AND THE PREVENTION OF POSTPUNCTURE HEADACHE

As the result of experiments made during 1923 and my experience since that time with the use of a small needle 1 having a round, sharp, tapering point, I am convinced that postpuncture headache is caused by trauma to the spinal dura sufficient to result in excessive leakage of cerebrospinal fluid to the point at which the brain is left without a water cushion. These experiments demonstrated that a greater trauma was produced by the use of a needle with a blunt cutting point than by a needle of the same caliber with a point rounded, tapering and sharp. It was also shown that leakage followed puncture of the spinal dura in every instance in which the membrane was suspended and filled with water, and that the amount of leakage was in direct relation to the size of the needle used (Fig. 1). The problem is, then, to do the