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What are Spinal Headaches?

By on August 3, 2012

A post-dural-puncture headache, also commonly called a spinal or epidural headache, is a complication that can occur due to an epidural or any type of lumbar puncture.

How Does It Happen

Procedures such as a spinal tap or an epidural require the membrane that surrounds the spinal cord to be punctured. This membrane contains the cerebrospinal fluid, which surrounds the brain and the spine. When a needle punctures the membrane, occasionally some of the spinal fluid can leak or drain out of the tiny hole that was created by the needle.

The average adult only has about 8 ounces of cerebrospinal to begin with. The fluid acts as a protectant for both the brain and the spine. When the spinal fluid leaks out into the body, it causes the brain to begin to literally sag down onto the spinal cord.

The sagging of the brain causes connective tissues and blood vessels to stretch, causing intense pain that is felt as an excruciating headache. The blood vessels in the brain may also start to dilate and expand, causing more pain.

How To Spot a Spinal Headache

After a spinal procedure, the anesthesiologist will recommend that you lie flat for a certain period of time, generally an hour. Thisgives the injection site time to heal to prevent leakages and spinal headaches. Anesthesiologists call it a ‘wet tap’ when they accidentally nic the membrane and cause the leakage. Anesthesiologists suggest that this is a complication that only occurs in about 1% of patients, but studies suggest it actually occurs in about 25%, or 1 in 4.

It is normal for a person who has undergone anesthesia or a spinal procedure to have a slight headache afterwards. If a woman received an epidural for delivery, her headache may be perceived as being from the delivery and pushing.

It is hard to diagnose a spinal headache as there are no tests that can be run. They are generally diagnosed when a patient has a persistent headache after a spinal procedure.Generally spinal headaches present themselves immediately following the removal of the needle from the spine. These headaches tend to start off mild and increase in intensity. They go away when you lay down flat, and get worse when you sit up or stand. The headache does not completely go away with any type of medication.Other symptoms that may present themselves include:● sensitivity to light
● nausea
● tinnitus, or ringing in the ears
● feeling dizzy
● stiffness in the neck
● dull pain in the head that throbsA doctor will take into consideration all symptoms before making a diagnosis.

Options for Treatment

A spinal headache can last up to two weeks, with the average time being five days. Usually it will take care of and heal itself. There are various things that can be done to try and relieve the pain and speed along the healing process.

The first course of treatment is hydration. A doctor may start an IV to fill you up on fluids, or may just suggest you drink a lot of water. This helps replenish the cerebrospinal fluids quicker. Another option is taking ibuprofen or aspirin to help with the swelling of the blood vessels in the brain. Prescription pain relievers may be given to help with the discomfort.

Sometimes the patient is given instruction to drink beverages that contain high levels of caffeine, since it can help with the constriction of blood vessels.

Patients are told to stay on strict bed rest for the next 24-48 hours. If you have a spinal headache, you should take it easy. There should be absolutely no bending, lifting, or twisting. Any type of fast or straining motion could re-tear the hole and prolong the healing process.

For patients whose spinal leakage does not resolve itself, a procedure called a blood patch can be performed by an anesthesiologist. During this procedure, the anesthesiologist will draw a tiny amount of blood from the patient. They then inject the blood into the space where the leak is occurring. The blood will coagulate, clot and fill up the space. Relief from a spinal headache through a blood patch is almost instantaneous.

Prevention and Long Term Effects

Unfortunately there is not much a patient can do to prevent a spinal headache. The best they can do is try to be as still as possible during the procedure to try to prevent it.

It is unknown the long-term effects of a spinal headache, if any. If you have experienced a spinal headache in the past, you may be more prone to headaches after having had a spinal headache.