Natural history of headache in patients with lymphocytic meningitis following lumbar puncture

Background Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is essential for diagnosis of meningitis. What is the impact of the procedure upon the natural history of headache and associated signs in patients with lymphocytic meningitis and what factors can have prognostic value for the future progression of symptomatology? This study was aimed at looking into these questions. Methods One hundred and one patients with clinical and laboratory diagnosis of aseptic meningitis answered a questionnaire intended at assessing the severity and nature of headache and meningeal irritation signs before and one, and twenty four hours after the LP. Later they were divided into three groups according to presence and type of headache after 24 h. Demographic and clinical data was obtained from patients files. Results There was almost 50% improvement in headache severity and associated signs after 24 hours from LP in the whole group of patients. Patients that did not have pain after 24 hours had higher BMI and lower headache severity one hour after LP compared to patients in the other groups (p = 0.064 and p = 0.005). Patients with papilledema had higher incidence of post dural puncture headache (PDPH). Conclusions Our study shows that patients with aseptic meningitis undergo improvement in all parameters of headache and also in signs of meningeal irritation following LP. Higher BMI and low headache intensity are positive prognostic factors for improvement of headache after 24 hours while papilledema is associated with a higher incidence of PDPH.