OpenHealth Q&A

Can Incomplete Lumbar Punctures Lead to RCVS?

**Patient Profile**: F29 **Past Medical History**: Endometriosis, chronic migraines (onset following lumbar puncture), irritable bowel syndrome (IBS), generalized anxiety disorder (GAD) **Current Medications**: Candesartan 8 mg every night, Sertraline 150 mg every night, Mirena coil in place. **Allergies**: Penicillin **Medical History**: In December 2021, the patient was hospitalized under suspicion of viral meningitis. Over a challenging six-day period (coinciding with a holiday), multiple attempts at the lumbar puncture (LP) were unsuccessful. Eventually, a successful LP led to a dural tear, necessitating two epidural blood patches for correction. The cerebrospinal fluid (CSF) analysis showed an elevated white blood cell count but was not conclusive for a meningitis diagnosis. The final diagnosis remained unclear, though idiopathic intracranial hypertension (IIH) was considered due to the patient experiencing persistent low-grade headaches daily, prompting the initiation of Candesartan. After the LP, the patient began experiencing a chronic migraine disorder that included aura, sensitivity to light, and episodes of nausea and vomiting. The headaches were notably severe, with some presenting as thunderclap headaches, requiring emergency intervention. Additionally, there was a transient episode of occipital neuralgia that resolved, although the patient reported allodynia on the scalp during hair care routines. In the summer of 2024, the patient was readmitted due to complications from endometriosis, which included urinary issues and numbness as well as nerve pain in the lower extremities, raising concerns about potential cauda equina syndrome (CES) or disc issues. A repeat LP was performed under fluoroscopic guidance by a consultant, which again resulted in a dural rupture and necessitated an additional blood patch. For migraine management, the patient utilizes caffeine (in the form of Coca-Cola), ibuprofen lysine at 342 mg, and sumatriptan at 50 mg as needed, yet the migraines persist, causing significant disability. **Current Concern**: There is a rising concern that the repeated lumbar punctures, especially those leading to dural damage and delayed collection of CSF, may have precipitated or exacerbated the transformation into chronic migraines or possibly triggered reversible cerebral vasoconstriction syndrome (RCVS). Although a formal diagnosis for RCVS has not been established, the symptoms overlap: the experience of thunderclap headaches, features consistent with migraines, and the unpredictable nature of their onset suggest a possible connection. There is inquiry into whether the frequent lumbar punctures could serve as a catalyst for this condition.

Answers (1)

7/24/2025, 9:10:42 PM

OpenHealth AI

It sounds like you’re experiencing a complex interplay of symptoms following multiple lumbar punctures (LPs) and are understandably concerned about their potential connection to conditions like chronic migraines or reversible cerebral vasoconstriction syndrome (RCVS).

Main Points:

1. Incomplete lumbar punctures and dural tears can lead to complications, but RCVS is typically associated with vasoconstriction and not directly caused by LPs.
2. Symptoms like thunderclap headaches and chronic migraines can arise from various factors, including neurological conditions, not solely due to LP complications.

Explanation:

Lumbar punctures can lead to complications, such as dural tears, which may contribute to persistent headaches or migraine-like symptoms. However, RCVS involves vasoconstriction of cerebral blood vessels, which isn't directly linked to LPs. Your history of thunderclap headaches and migraine features raises important questions about potential triggers and underlying conditions.

Chronic migraines can be exacerbated by other neurological conditions, stress, or even medication side effects. The symptoms you've described, including allodynia and severe migraine episodes, could be indicative of chronic migraine syndrome and may require tailored management approaches.

Next Steps:

1. Track Your Symptoms: Maintain a detailed diary of your headaches, noting their frequency, intensity, triggers, and any associated symptoms. This information can be invaluable for understanding patterns and guiding treatment.

2. Evaluate Medications: Consider discussing your current migraine management strategy with your healthcare provider. Adjusting medication dosages or exploring alternative treatments, such as preventive medications, might be beneficial.

3. Manage Stress: Since you have a history of generalized anxiety disorder, incorporating stress management techniques like mindfulness, cognitive behavioral therapy, or relaxation exercises may help reduce headache frequency.

4. Consult with Specialists: If you haven’t done so recently, discuss with a neurologist the possibility of RCVS or other neurological assessments that could clarify your symptoms. This could include imaging studies or evaluations specific to your migraines.

5. Hydration and Caffeine: Keep hydrated and monitor your caffeine intake. While some find relief with caffeine, others may experience increased headache frequency; identifying what works best for you is critical.

These practical steps can help you proactively manage your symptoms and work towards finding effective solutions. Please feel free to reach out if you have more questions or need further guidance.