Spinal Headache: Overview, Signs, Diagnosis and Treatment

OVERVIEW

A spinal headache, also called a post-dural puncture headache, is a headache that can follow a spinal tap, spinal anesthesia or an epidural. It happens when cerebrospinal fluid (CSF) leaks out through a small hole in the dura, the membrane that surrounds the brain and spinal cord.

The leak lowers the fluid pressure around the brain, especially when you sit or stand. This puts strain on pain-sensitive structures around the brain and causes the headache.

Spinal Headache

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WHAT IS SPINAL HEADACHE?

A spinal headache typically gets better when you lie flat and worse when you sit up or stand. It can last from a few days to a week or more if untreated.

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It is caused by a puncture of the dura, which changes the amount of CSF around the brain and spinal cord. A spinal needle passes through the dura on purpose, while an epidural needle can go through it by accident.

According to Cambridge University Hospitals (NHS), about 1% of people who have an epidural or spinal anesthetic develop this headache. The risk after a diagnostic spinal tap can be higher and depends on factors such as needle size and type.

Spinal Headache Symptoms

This headache usually starts between one day and one week after the procedure. Symptoms are often worst at first and ease as the hole in the dura heals. The symptoms of spinal headache include

pain in the neck
stiffness of the neck and pain on movement
nausea and vomiting
sensitivity to bright light
hearing changes, such as ringing or muffled hearing, or vision changes
a severe headache, felt at the front or the back of the head
The headache has more of a throbbing or dull, aching character for some people
pain that gets worse when you sit up or stand and eases when you lie down
pain that gets worse with straining, coughing or sneezing

What Is The Mechanism Of Such Kind Of Headache?

This headache follows a needle puncture into the spinal canal. Doctors do a spinal tap (lumbar puncture) to collect a sample of CSF to diagnose certain conditions, and they inject anesthetic into the same space for spinal anesthesia before some surgeries.

The needle is placed in the lower back, usually between the L3 and L4 or L4 and L5 vertebrae. This is below the point where the spinal cord ends, so the needle enters the fluid-filled space without touching the cord. If fluid keeps leaking through the hole the needle leaves, pressure around the brain drops and the headache develops.

How The Doctor Diagnose Your Condition?

When you see a doctor, they will ask about your history and symptoms, such as

whether you recently had a spinal tap, spinal anesthesia or an epidural
whether the pain gets worse with coughing or sneezing
whether the pain eases when you lie down
whether caffeine helps the headache
whether the headache is getting better on its own

The doctor will also check the puncture site for signs of infection or bleeding. The diagnosis is usually based on your symptoms and recent procedure.

MAGNETIC RESONANCE IMAGING (MRI)

An MRI is not always needed. It may be used if the diagnosis is unclear or the doctor wants to rule out other causes, such as bleeding or infection. It can sometimes show signs of low CSF pressure.

TREATMENT OF SPINAL HEADACHE

Many spinal headaches get better on their own within a few days to a week with simple care. MedlinePlus lists rest, fluids, caffeine and pain relievers, with a blood patch if the headache lasts more than a week.

Painkillers: simple pain relievers such as acetaminophen or ibuprofen can ease the pain while the hole heals.
Caffeine: caffeinated drinks such as coffee or tea may help lessen the pain.
Rest and fluids: lying flat often relieves the pain, and drinking plenty of fluids may help. Avoid heavy lifting and straining.
Blood patch: if the headache is severe or doesn't improve, a doctor may suggest an epidural blood patch. A small amount of your own blood is injected near the hole to seal it and restore normal CSF pressure. It cures the headache within 24 hours in about 60-70% of cases and can be repeated if needed.

How Does It Feel Like To Have Such Kind Of Headache?

It is often a severe headache. It gets worse within minutes of sitting up or standing and improves when you lie down in a comfortable position.

Seek urgent care if the headache comes with fever, confusion, seizures, weakness or a stiff neck that doesn't ease when lying down, or if it is unlike what your care team told you to expect. These can signal other problems that need prompt treatment.

PREVENTION

This headache can't always be prevented, because spinal taps and spinal anesthesia are sometimes necessary for diagnosis or surgery. Using smaller or specially shaped (pencil-point) needles lowers the risk.

CONCLUSION

A spinal headache is a severe headache that can follow a spinal tap, spinal anesthesia or an epidural. It gets worse when you sit or stand and eases when you lie down. It usually goes away on its own within about a week, and an epidural blood patch can treat headaches that last.