A spinal headache is caused by spinal fluid leaking through the puncture site after a spinal anesthesia or lumbar puncture. Symptoms include ringing in the ears, dizziness, visual field disruptions, and nausea. Treatment includes lying down, analgesics, fluids, caffeine, and a blood patch. The condition is more common in people with a history of headaches.
A spinal headache is a headache that occurs after the membrane surrounding the spinal cord has been punctured, as occurs in spinal anesthesia and lumbar punctures. The headache is caused by spinal fluid leaking through the puncture site and usually occurs between 12 hours and one day after the puncture procedure. Spinal headaches generally resolve on their own, but they can be painful and uncomfortable, leading many patients to seek treatment for pain relief.
Classically, a spinal headache occurs when a patient changes position, from a prone position to standing or sitting. Patients may experience a sensation of ringing in the ears, dizziness, visual field disruptions, and nausea. When they lie down, symptoms usually ease, and the treatment recommendation for a spinal headache is often to simply lie down and allow the headache to resolve while the puncture site heals and pressure is restored.
Patients may also be given analgesics to relieve pain, and fluids may be given intravenously or by mouth in an attempt to raise pressure and resolve the headache. Caffeine can also be given to constrict blood vessels, which will raise the pressure. Spinal headaches can also be treated with a blood patch, in which a small amount of the patient’s blood is carefully injected into the puncture site to create a clot that seals it, preventing fluid from leaking.
Also known as post dural puncture headache (PDPH), a spinal headache is a known side effect of procedures in which the dura is punctured. Special care is taken to reduce the risk of developing a spinal headache, including using small needles for such punctures to minimize spinal fluid leakage. The frequency of spinal headaches varies, with up to 25% of patients developing headache after a puncture of the dura. The condition is more common in people who have a history of headaches.
Epidural anesthesia can also lead to a spinal headache, although the dura is not punctured during this anesthetic procedure. If the anesthetist accidentally nicks or punctures the dura, allowing spinal fluid to leak out, a headache may appear. Patients should report headaches and other side effects after procedures involving the spinal cord so their doctors can be aware of them, and headaches that persist more than 24 hours should be treated more aggressively.
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