Patient education: Spinal headache (The Basics)

What is a spinal headache? — 

This is a type of headache that can happen after 1 of the following procedures:

●A lumbar puncture ("LP") – This is also called a "spinal tap." It is a procedure doctors use to get a sample of fluid from around the spinal cord. This fluid is called "cerebrospinal fluid," or "CSF."

●Spinal anesthesia – This is done in a similar way to an LP. Doctors use a needle to inject anesthesia medicines into the CSF. This is a way to block pain, for example, during surgery or childbirth.

To do an LP or give spinal anesthesia, the doctor inserts a needle into your lower back, between 2 of the bones. The spinal cord and CSF have a covering called the "dura." The needle goes through the dura so the tip is in the CSF (figure 1).

It's not clear exactly what causes a spinal headache in some situations. Doctors think it might be related to CSF leaking out through the hole in the dura.

A spinal headache is usually worse when standing or sitting, and gets better when lying down. It is also called a "postdural puncture headache" or "post-lumbar puncture headache."

Who is at risk for a spinal headache? — 

It's not possible to know exactly who will get a spinal headache after having an LP or spinal anesthesia. But there are some things that might make it more likely.

Your risk might be higher if:

●You are female.

●You are pregnant.

●You have had headaches often in the past.

●You are younger than 50.

●Your doctor uses a certain type of needle to do the LP – Larger needles, and needles with a certain tip shape, can raise your risk of spinal headache.

Will I get a headache after an epidural? — 

An "epidural" is similar to spinal anesthesia. A doctor puts a needle into your lower back, like for an LP. But instead of making a hole in the dura, the doctor keeps the needle tip in the space around the dura. Then, they insert a thin tube called a "catheter" in that space. The catheter is left in place to deliver medicine to the area.

Headaches don't happen very often after an epidural. But they can happen if the needle accidentally goes into the dura and makes a hole.

What are the symptoms of a spinal headache? — 

The main symptom is a headache, usually in the front or back of the head. The headache gets worse if you sit or stand up, and gets better when you lie down.

Many people get other symptoms, too. They include:

●Nausea

●Stiff neck

●Low back pain

●Dizziness

●Vision problems, such as double vision, blurry vision, or being bothered by light

●Hearing problems, such as ringing in the ears or temporary hearing loss

Will I need tests? — 

It depends. Your doctor or nurse should be able to tell if you have a spinal headache by learning about your symptoms and doing an exam.

Depending on your symptoms, you might get tests to make sure something else is not causing your headache. These can include imaging tests such as a CT scan or MRI. These create pictures of the brain.

How is a spinal headache treated? — 

In most cases, a spinal headache goes away on its own, usually within a week. Depending on how severe your headache is, there are different treatments that can help:

●Mild headache – You can take pain medicines like acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). Caffeine might help, especially if you are used drinking caffeinated drinks (such as coffee) every day. If you have nausea, your doctor can give you medicines to help with this.

●Severe headache – If your headache is severe, for example, so bad you cannot sit or stand, your doctor might suggest a "blood patch." This involves taking a small amount of your blood and injecting it into the area where the hole was made.

Can a spinal headache be prevented? — 

No. There is no way to completely prevent a spinal headache after having an LP or spinal anesthesia. But your doctor might be able to lower the risk by using a smaller needle with a certain kind of tip.

More on this topic

Patient education: Headaches in adults (The Basics)
Patient education: Lumbar puncture (spinal tap) (The Basics)
Patient education: Anesthesia in adults (The Basics)

Patient education: Headache causes and diagnosis in adults (Beyond the Basics)