Spinal headaches

Overview

Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the 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During a spinal tap, a sample of cerebrospinal fluid is withdrawn from the spinal canal. During spinal anesthesia, medication is injected into the spinal canal to numb the nerves in the lower half of the body. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache.

Most spinal headaches — also known as post-dural puncture headaches — resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment.

Symptoms

Spinal headache symptoms include:

• Dull, throbbing pain that varies in intensity from mild to very severe
• 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:

• Dizziness
• Ringing in the ears (tinnitus)
• Hearing loss
• Blurred or double vision
• Sensitivity to light (photophobia)
• Nausea and vomiting
• Neck pain or stiffness
• Seizures

When to see a doctor

Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up or stand.

Causes

Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) 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 48 to 72 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

Risk factors for spinal headaches include:

• Being between the ages of 18 and 30
• Being female
• Being pregnant
• Having a history of frequent headaches
• Undergoing procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord
• Having a small body mass

Diagnosis

The provider 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 provider will recommend 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 the brain.

Treatment

Treatment for spinal headaches begins conservatively. Your provider may recommend getting bed rest, drinking plenty of fluids, consuming caffeine and taking oral pain relievers.

If your headache hasn't improved within 24 hours, your provider might suggest an 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.

Preparing for an appointment

If you've recently had a spinal procedure and develop a headache that lasts 24 hours or longer, your provider 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 provider.

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 that you miss or forget.
• Write down questions to ask your provider.

Preparing questions can help you make the most of your time with your provider. 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 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 provider 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?