Certified Ambulatory Perianesthesia Nurse (CAPA) Practice Exam

A patient is experiencing a postural puncture headache. What is this condition most often attributed to?

1. Elevating the head of the bed too soon

2. A previous post Dural puncture headache

3. Being NPO for a long period preoperatively

4. The size of the needle used for the puncture

The correct answer is: The size of the needle used for the puncture

A postural puncture headache, also referred to as a post-dural puncture headache, occurs when there is a leak of cerebrospinal fluid (CSF) through the hole created by a lumbar or epidural needle puncture. This condition is most often attributed to the size of the needle used for the puncture. Specifically, larger gauge needles tend to create a larger defect in the dura mater, increasing the likelihood of CSF leakage and thus elevating the risk for developing a headache. In clinical practice, the aspiration of CSF is usually done with a smaller gauge needle whenever possible to minimize this risk. The diameter of the needle directly impacts how much fluid can escape, culminating in a postural headache when the patient is upright or even sitting, due to decreased intracranial pressure. Other factors such as patient positioning or preoperative NPO status can contribute to discomfort or complicate surgical recovery, but the specific association with postural puncture headaches is closely linked to the physical properties of the needle used during the procedure.