Low-pressure headaches are caused by a drop in cerebrospinal fluid and are often associated with lumbar punctures or spinal fluid leaks. Symptoms include severe pain at the back of the head, nausea, and neck pain. Treatment involves bed rest, fluids, and pain relief medication. An epidural patch may be used for persistent headaches.
A low pressure headache is normally attributed to a drop in cerebrospinal fluid (CSF). CSF, or spinal fluid, refers to the clear, watery fluid that surrounds the brain and spine and works to provide cushioning and support to these areas. Because CSF is often the cause of a low-pressure headache, this type of headache may also be known as a low-pressure headache of the cerebrospinal fluid.
Low pressure headaches are more likely to occur after a lumbar puncture. Also known as a spinal tap, this medical procedure usually involves inserting a needle between two vertebrae in the lower back. Once the needle advances toward the spine, CSF pressure is tested and fluid is withdrawn. The test is typically done to check for serious infections and various medical conditions related to the central nervous system, such as syphilis, multiple sclerosis, and encephalitis. These headaches can occur after a lumbar puncture because the reduction in spinal fluid can cause the brain to sag downward when the patient stands, causing strain and pain.
Although lumbar punctures are the most commonly recognized cause of low pressure headaches, any event that causes a spinal fluid leak can also cause such headaches to occur. A skull fracture, for example, can lead to a sudden reduction in the volume and pressure of the cerebrospinal fluid, causing headaches. Hydrocephalus, a medical condition involving excessive buildup of cerebrospinal fluid, is often treated with a shunt to drain the excess fluid. In some cases, the shunt can become overloaded, causing headaches.
Symptoms of a low-pressure headache include severe pain toward the back of the head that’s usually worse when standing, sitting, or moving. Nausea, vomiting, and neck pain may also occur. The headache may begin to occur just a few hours after spine surgery, and in some cases, it can persist for days or weeks.
Regardless of the cause of the pain, however, the typical treatment is bed rest because lying flat reduces the effects of gravity and helps slow the loss of spinal fluid. Drinking plenty of fluids and taking over-the-counter pain relievers that contain acetaminophen can also be used to help prevent or relieve headaches. Caffeine can also be consumed in the form of pills or drinks for pain relief. For a low-pressure headache that persists for more than a few days, an epidural patch may be applied. Using the patches involves applying the patient’s clotted blood to the lumbar puncture area to seal the leak and prevent any further CSF drainage.
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