امرأة عمرها ٢٩ سنة عُمل لها بزل قطني أمس لاستبعاد التهاب السحايا وكانت النتيجة طبيعية. اليوم تشتكي صداعاً يزيد عند الجلوس والوقوف ويخف عند الاستلقاء، بدون حرارة أو تصلب رقبة. ما التفسير والتدخل الأول؟

A 29-year-old woman had a lumbar puncture yesterday to exclude meningitis, with normal results. Today she has a headache worse sitting and standing and relieved lying down, without fever or neck stiffness. What is the explanation and first intervention?

1. Migraine needing a subcutaneous triptan
2. Post-puncture headache; rest, fluids and analgesia
3. Brain haemorrhage needing an urgent CT before anything
4. New meningitis needing IV antibiotics immediately

Answer: B) Post-puncture headache; rest, fluids and analgesia. Positional headache after LP comes from CSF leaking at the puncture site. It is treated with fluids, caffeine and analgesia, and an epidural blood patch if it persists.