Spinal headaches

Definition

Spinal headaches occur in up to 30 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, 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During a spinal tap, a sample of cerebrospinal fluid is withdrawn from your spinal canal.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.

Symptoms

Spinal headache symptoms include:

• 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:

• Dizziness
• Ringing in the ears
• Nausea
• Visual changes

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.

Causes

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 anesthesia 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 a woman
• Having a personal history of headaches in general
• Being between the ages of 20 and 40
• 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, you probably know your risk of getting a spinal headache. But if you're experiencing unforeseen symptoms or your headache concerns you for any reason, your doctor can help you determine the seriousness of your condition and whether you need to be seen immediately. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restricting your diet.
• 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, as well as any vitamins and supplements, that you're taking.
• Take a family member or friend along, if possible. Depending on your condition, you may need assistance getting to your appointment. Also, sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For a spinal headache, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing your headache?
• Does your headache worsen when you sit, stand or lie down?

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) exam to exclude other causes of the headache. During the exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

Treatments and drugs

Treatment for spinal headaches begins conservatively. Your doctor may recommend bed rest 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.
• Intravenous 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 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.