IV Theophylline Quickly Reduces Lumbar Puncture Headache

Daniel M. Keller, PhD

June 04, 2014

ISTANBUL, Turkey — Intravenous (IV) theophylline promptly relieves the common problem of headache after lumbar puncture, according to the results of a small study.

In the study, mean pain scores were reduced by half within 30 minutes of treatment without adverse effects, researchers reported in a poster presentation here at the 24th Meeting of the European Neurological Society (ENS).

Lumbar puncture headache is believed to result from leakage and depletion of cerebrospinal fluid, causing traction on or distortion of anchoring pain-sensitive structures in the brain resulting in orthostatic headache. There may also be an effect of physical changes in the cerebral veins and venous sinuses.

Theophylline (1,3-dimethylxanthine) is an adenosine receptor antagonist and may act by reducing intracranial blood flow and venous engorgement.

Treatment options for post–lumbar puncture headache include oral overhydration, caffeine, or theophylline, as well as adrenocorticotropic hormone, sumatriptan, pregabalin, epidural saline, and epidural patches, said study coauthor Ufuk Ergün, MD, an associate professor at the Ministry of Health Ankara Education and Research Hospital in Turkey.

Dr. Ergün and colleagues investigated the efficacy and time frame for pain relief using IV theophylline in 7 patients aged 65 years or younger with post–lumbar puncture headache. Patients were excluded if they had central nervous system infections or malignancies, intracranial hemorrhage, hydrocephalus, systemic or intracranial hypertension, convulsions, or cardiac arrhythmia. Patients had a mean age of 38.4 years (range, 17 to 60 years); 3 of the patients were women. Four had diagnostic lumbar punctures, and 3 had spinal anesthesia for common operations.

Researchers administered theophylline, 200 mg in 100 mL of IV 5% dextrose, over 40 minutes. Patients in a sitting position reported pain on a 10-point visual analogue scale (VAS) at time 0 and at 30 and 60 minutes after the beginning of the infusion.

All patients reported relief of pain at 30 and 60 minutes, with the greatest percentage decrease seen at 30 minutes. All but 2 patients had additional relief at 60 minutes; 1 patient had a 1-point increase and 1 had no change compared with the 30-minute VAS score.

Table. Relief of Post–Lumbar Puncture Headache by IV Theophylline (VAS Score)

Patient VAS Score: 0 min VAS Score: 30 min (% Decrease From 0 min) VAS Score: 60 min (% Decrease From 0 min)
1 10 7 (30.0) 5 (50)
2 8 5 (37.5) 3 (62.5)
3 10 3 (70) 4 (60)
4 5 1 (80) 1 (80)
5 6 4 (33.3) 2 (33.3)
6 7 4 (42.8) 3 (57.1)
7 5 3 (40.0) 2 (60)

 

Mean pain score was 7.2 at time 0 of the infusion, 3.8 after 30 minutes, and 2.8 at 60 minutes. Dr. Ergün said these findings are consistent with the researchers' previous observations. No patient reported any adverse effects.

The researchers concluded that IV theophylline is a noninvasive, easy, safe, and relatively rapid remedy for post–lumbar puncture headaches.

Worth a Try

The poster caught the eye of several physicians wandering by, who said, after viewing it, that they are apt to try the treatment for their patients with post–lumbar puncture headache.

 
For IV theophylline, this is really promising because in 30 minutes you can abolish the headache. Dr. Ibrahim Elminshawy
 

One observer was Ibrahim Elminshawy, MD, assistant professor of neurology at Mansoura University in Egypt, who said his current practice is to expand intravascular fluid with saline, which eventually leads to more cerebrospinal fluid production, or to give high-dose caffeine. "But this is an oral medication that usually takes time with recumbency," he said. "For IV theophylline, this is really promising because in 30 minutes you can abolish the headache."

Dr. Elminshawy said the decreases in pain shown in the data are clinically significant and the treatment is something he would "definitely" try.

Another physician viewing the poster was also positive about the treatment but said he would be concerned about using it in older patients or patients with cardiovascular disease.

There was no commercial funding for the study. The authors and Dr. Elminshawy have disclosed no relevant financial relationships.

24th Meeting of the European Neurological Society (ENS): Abstract PP1104. Presented May 31, 2014.

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