Post Lumbar Puncture Headache

[Mint32]

I have had a post lumbar puncture headache resulting from a myleogram for 2 months now.  I have had 2 blood patches (one on day 3 which worked immediately but only lasted one day, and a second at week 6 which didn’t work, and actually immediately exasperated my symptoms.)  I have ruled out a secondary headache under the guidance of a neurologist, after spending 3 days in the hospital receiving DHE, along with Regelin and Compazine and IV fluids.  None of these treatments have helped, and my symptoms are still very positional.  I also had an MRI of the brain with and without contrast which ruled out any major complications (i.e. subdural hematoma) and did not show menigeal enhancement.  Based on my MRI, one neurologist I saw recommended waiting this out, in the expectation that my dura will eventually heal.  He did say if it got worse to go in and try another blood patch before I did anything more invasive.  However, another neurologist I spoke to wants to do a lumbar puncture to test the pressure of CSF and attempt to locate the leak, and possibly do surgery down the road.  I am extremely leary of doing yet another lumbar puncture right into the dura, which could result in yet another leak.

I would really appreciate your professional opinion in this situation.  

1. What is the longest spinal headache you have seen in a patient?

2.             How much longer would you recommend waiting in the expectation this will heal?  At what point would you try a 3rd blood patch?  (I'm thinking of having a fluoroscopy-guided blood patch soon, but I have also read that sometimes if 2 blood patches haven’t worked, it is unlikely a 3rd will work also.)  

3. At what point would you consider a surgical repair of the dura?

4. In your opinion, would an MRI of the lumbar spine give any valuable information?

THANK YOU so much for your time and expertise… It is very much appreciated!!