Headache Following Spinal Puncture

To the Editor:—  Some points should be brought out as to the nature of the type of headache which occurs after spinal puncture. Kaplan, as quoted in medical news (JAMA192, June 28, 1965, adv p 32) concluded that the principal cause is psychosomatic. The etiology "is still unsettled, although the bulk of the evidence supports the view that it is due to continued leakage of cerebrospinal fluid through the dural hole, resulting in lowered spinal fluid pressure and traction on pain-sensitive vascular structures." I thought this had been definitely proved. Be that as it may, unless each subject gave a description compatible with the definition of a postpuncture headache, although the statistics may be valid, the patients' complaints of headache may not necessarily be due to lumbar puncture.The characteristics of a postpuncture headache are: (1) It occurs after spinal puncture; whether or not the patient is aware that