In the International Headache Society (IHS) classification category, headache related to intrathecal injections is a direct effect of the agent with the following diagnostic criteria (Table 6): if the headache is because of presumed chemical meningitis, the IHS criteria specify the criteria listed in Table 7.
From a clinical standpoint, there may be diagnostic confusion of headache because of a low cerebrospinal fluid (CSF) pressure or post-lumbar puncture (LP) headache, as opposed to a "pure" headache related to intrathecal injections. Headaches after intrathecal injections may be seen after many agents, including anesthetics, inadvertent intrathecal injections of blood patches, chemothera-peutic agents, and gadolinium; the headache may be dose-limiting in some cases. The relationship of more remote complications, such as cerebral ischemia or cerebral venous thrombosis to postdural puncture syndromes, is more obscure, although vascular mechanisms may be related to the pathogen-esis of post-LP and intrathecal injection headaches. The choice of smaller needles used in the lumbar puncture with injections of cytotoxic chemicals for chemotherapy has been cited as one method to lower the incidence of intrathecal injection headache.
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