Spinal Tap for Migraine or Headache Diagnosis?

Health Professional

Full Question:

I have migraine causing refractory headaches for 10 years now, as well as severe osmophobia and chemical sensitivity.

My long-term neurologist is very helpful and has helped me try many many preventive medications and procedures (sphenocath and botox) to no avail.

Recently, he suggested a spinal tap that might tell us something more about the headache and visual symptoms I have. How helpful is spinal tap for diagnosis of headache or migraine disorders and specifically for which ones? Is there a risk to my migrainous nervous system? Seems like a pretty invasive procedure.

I'm speaking to my neurologist about this but would value your input as well.
Thank you, Suki.

Full Answer:

Dear Suki:

A lumbar puncture (spinal tap) is sometimes performed for migraine patients to rule out a condition called idiopathic intracranial hypertension (IIH), aka pseudotumor cerebri. IIH is a condition in which the body produces too much cerebrospinal fluid or doesn't process it correctly, resulting in high cerebrospinal fluid pressure. IIH can trigger migraine attacks, and it can reduce the effectivness of preventive treatments. When a migraine patient can't identify the triggers for a significant percentage of their migraine attacks, particularly when trials of preventive medications have failed, it makes sense to do a lumbar puncture to test for IIH. In some patients, a thorough eye examination may reveal papilledema, swelling of the optic nerve. Papilledema doesn't always occur with IIH, and a lumbar puncture is the diagnostic test that can definitively diagnose or rule out IIH. You can read more about IIH in Idiopathic Intracranial Hypertension (IIH) – The Basics.

A lumbar puncture is also used to diagnose meningitis, which can cause severe headaches, and headache disorders caused by irregularities in cerebrospinal fluid pressure. These include headache related to increased cerebrospinal fluid pressure and headache attributed to low cerebrospinal fluid pressure.

When performed by a physician who is both skilled and experienced in performing lumbar punctures, the procedure is safe and relatively simple. Some people do get a "spinal headache" after a lumbar puncture, but most people experience no ill effects and can return to their "normal" activities the next day.

Thanks for your question,
David Watson, MD, and Teri Robert


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Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. He and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about _ Dr. Watson_ or more about _** Teri Robert** _.

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