Abstract: To performe a systematic literature review of randomised controlled trials to assess if bed rest can prevent postpunctural headache. Study selection We searched EMBASE (89-9/99), MEDLINE (r) (66-9/99), PASCAL BioMed (96-9/99), CC Search (r) CSI (97-9/99), PsychLIT (70-9/99), the Cochrane Controlled trial register, textbooks and references of the papers selected. The search term was [(headache or cephalea or cephalalgia) and (bed rest or bedrest or bed-rest or posture or recumbency or recumb*) and (lumbar or postlumbar or spinal or dural or puncture or punct* or postpunct*) and (randomised or randomized or randomi*)]. Studies were eligible if patients underwent lumbar or suboccipital puncture for any reason and were randomised to a prolonged period of bed rest in one group and a short period of bed rest in another group and if the occurrence of headache was recorded in absolute numbers. Data extraction Data were abstracted by two investigators independently and in duplicate to a predefined form. Data synthesis We found 15 randomised controlled trials with 1001 patients assigned to immediate mobilsation or a short period of bed rest and 1050 patients assigned to a long period of bed rest (see figure). There was clinical and statistical heterogeneity so we did not attempt quantitative data synthesis. The frequency of headache ranged from 9% to 60%. None of the studies, however, showed that bed rest was superior to early mobilisation for preventing postpunctural headache in any of the clinical situations described. In general it appeared that there was no difference in headache between the groups and in two studies bed rest increased the frequency of headache significantly; both studies included relatively small numbers of patients.

Conclusion: There was no evidence that bed rest after cervical or lumbar puncture helps to reduce the occurrence of headache.