A single copy of this article may be reprinted for personal, noncommercial use only.
Spinal headachesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/spinal-headaches/DS00643
Spinal headaches occur in up to 40 percent of those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the tough membrane that surrounds the spinal cord and, in the lower spine, the lumbar and sacral nerve roots.
During a spinal tap, a sample of cerebrospinal fluid is withdrawn from your spinal canal. During spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache.
Most spinal headaches — also known as post-lumbar puncture headaches — resolve on their own with no treatment. However, spinal headaches lasting 24 hours or more may need treatment.
Spinal headache symptoms include:
- Dull, throbbing pain that varies in intensity from mild to incapacitating
- Pain that typically gets worse when you sit up or stand and decreases or goes away when you lie down
Spinal headaches are often accompanied by:
- Ringing in the ears (tinnitus)
- Light sensitivity (photophobia)
- Neck stiffness
When to see a doctor
Tell your doctor if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up or stand.
Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache.
Spinal headaches typically appear within 12 to 24 hours after a spinal tap or spinal anesthesia. Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured.
Risk factors for spinal headaches include:
- Being a woman
- Having a history of spinal headaches
- Being between the ages of 18 and 30
- Undergoing procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord
Preparing for your appointment
If you've recently had a spinal procedure and develop a headache that lasts 24 hours or longer, your doctor can help you determine the seriousness of your condition. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of all medications, vitamins and supplements you're taking.
- Take a family member or friend along, if possible. Depending on your condition, you may need help getting to your appointment. And, someone who accompanies you may remember information you miss or forget.
- Write down questions to ask your doctor.
Preparing questions can help you make the most of your time with your doctor. For a spinal headache, questions you might ask include:
- What is likely causing my symptoms or condition?
- Are there other causes?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What alternatives are there to the approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions I need to follow?
- Should I see a specialist?
- Are there brochures or other printed material that I can take? What websites do you recommend?
Don't hesitate to ask any other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- When did your headache begin?
- Does your headache worsen when you sit, stand or lie down?
- Do you have a history of headaches? What type?
Tests and diagnosis
The doctor will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures — particularly a spinal tap or spinal anesthesia.
Sometimes the doctor will recommend a magnetic resonance imaging (MRI) to rule out other causes of your headache. During the exam, a magnetic field and radio waves create cross-sectional images of your brain.
Treatments and drugs
Treatment for spinal headaches begins conservatively. Your doctor may recommend bed rest, fluids, caffeine and oral pain relievers. If your headache hasn't improved within 24 hours, your doctor may suggest one or more of the following treatments:
- Epidural blood patch. Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache. This is the usual treatment for persistent spinal headaches that don't resolve on their own.
- IV caffeine. Delivered directly into your bloodstream, caffeine helps relieve spinal headaches — usually within a few hours — by constricting blood vessels within your head.
- Epidural saline. Injecting a saltwater (saline) solution into the space outside the membrane that covers your spinal cord may put pressure on the lumbar puncture site and stop the cerebrospinal fluid leak. But because saline solution is absorbed so quickly by the body, spinal headaches often recur after this treatment.
- Postdural (post-lumbar) puncture headache. International Headache Society. http://ihs-classification.org/en/02_klassifikation/03_teil2/07.02.01_nonvascular.html. Accessed Feb. 7, 2012.
- Primary headache disorders, including migraine. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm#142883138. Accessed Feb. 7, 2012.
- Post-lumbar puncture and other low-pressure headaches. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec16/ch216/ch216e.html. Accessed Feb. 7, 2012.
- Guideline summary NGC-4514. National Guideline Clearinghouse. http://www.guideline.gov/content.aspx?id=8102. Accessed Feb. 7, 2012.
- Boonmak P, et al. Epidural blood patching for preventing and treating post-dural puncture headache (Review). The Cochrane Collaboration. 2010;1:1.
- Basurto Ona X, et al. Drug therapy for treating post-dural puncture headache (Review). The Cochrane Collaboration. 2011;8:1.
- Lavi R, et al. Lumbar puncture: It is time to change the needle. European Neurology. 2010;64:108.