Predictors of post-lumbar puncture headache in an academic outpatient neurology setting: a retrospective exploratory study.

BACKGROUND: Post-lumbar puncture headache (PLPH) is the most frequent complication of diagnostic lumbar puncture (LP). Data from academic outpatient neurology settings are limited, although these environments are increasingly relevant for both clinical care and resident training. METHODS: We retrospectively analyzed consecutive cases of diagnostic LP. Procedures were performed by first-year neurology residents under supervision, using 22-gauge cutting bevel needles, in an academic outpatient setting. The primary outcome was PLPH incidence; secondary outcomes included other complications. Exploratory univariate logistic regression was performed to identify predictors of PLPH. RESULTS: A total of 177 patients (mean age 58.0 ± 16.5 years; 52% female) were included. PLPH occurred in 11 patients (6.2%), with a mean onset of 36.7 ± 25.7 hours and mean duration of 3.7 ± 1.9 days. Younger age and a higher number of puncture attempts were significantly associated with PLPH. Other variables, including gender, BMI, CSF volume collected, and patient position, were not significantly associated. Other complications were rare and self-limiting. CONCLUSIONS: In this real-world academic outpatient setting, PLPH incidence was 6.2%. Younger age represented a non-modifiable predictor, whereas multiple puncture attempts emerged as a potentially modifiable factor. These findings underscore the importance of procedural planning and structured supervision, and support the implementation of simulation-based educational strategies to reduce complication rates among trainees.