Review of the literature on prevention of post-lumbar puncture headaches (PLPHAs) since the publication of the original assessment in 2000 yielded one study comparing use of cutting to atraumatic needles in diagnostic lumbar punctures, providing Class I evidence in favor of the atraumatic needle. Taken in conjunction with data from most studies in the anesthesiology literature, the Therapeutics and Technology Assessment Subcommittee concluded that use of an atraumatic spinal needle in adult patient populations reduces the frequency of PLPHA (Level A recommendation). It affirmed a previous conclusion that smaller needle size is associated with reduced frequency of PLPHA (Level A recommendation).