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Objective: To assess the incidence of postdural puncture headache (PDPH) using 22‐gauge atraumatic needle (Sprotte, 22GS) compared with 22‐gauge traumatic needle (Quincke, 22GQ). Background: Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of 22GS, European neurologists seem to keep using 22GQ. Methods: This was a randomized, double‐blind study. Adults (age: 18–60 years) scheduled for dLP were included. dLP and CSF acquisition were performed in accordance with highly standardized procedures. Patients were followed up on days 2 and 7. Results: In total, 172 patients were randomized and lumbar punctured, and 21 were excluded due to wrong inclusion (n = 11), needle switch (n = 7), failed dLP (n = 1), withdrawal (n = 1), and missed follow‐up (n = 1). Among the remaining 151 patients (mean age: 40.7 ± 12.4 years), 77 had dLP using 22GQ and 74 using 22GS. Incidence of PDPH among patients punctured with 22GS (18%) was significantly lower (p =.004) than among patients punctured with 22GQ (39%). Relative risk was 0.45, 95% CI 0.26–0.80. Patients with PDPH had significantly lower weight (p =.035), and there was no significant difference related to age (p =.064), sex (p =.239), height (p =.857), premorbid episodic migraine (p =.829), opening pressure (p =.117), operators (p =.148), amount of CSF removed (p =.205), or number of attempts (p =.623). Conclusions: The use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use. [ABSTRACT FROM AUTHOR]