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Patient education: Spinal headache (The Basics)

Patient education: Spinal headache (The Basics)

What is a lumbar puncture? — A lumbar puncture ("LP") is a procedure doctors use to get a sample of the fluid around the spinal cord. It is also called a "spinal tap."

The spinal cord is a bundle of nerves that runs from the base of the brain down the back, inside the bones of the spine. It is surrounded by fluid called "cerebrospinal fluid" ("CSF"). The spinal cord and CSF have a covering called the "dura." To do an LP, the doctor inserts a needle into your lower back, between 2 of the bones. The needle goes through the dura so that the tip is in the CSF (figure 1).

Doctors might do an LP for different reasons, including to:

Check for problems that affect the brain or spinal cord

Give medicine directly into the area surrounding the spinal cord

Do a "myelogram" – This is a special kind of X-ray that involves injecting dye into the CSF.

What is a spinal headache? — A spinal headache is a headache that can sometimes happen within a few days after a person has an LP. This happens because the spot where the needle goes into the dura does not always close up right away. If the hole stays open, CSF can leak out. This lowers the pressure inside the skull, causing a headache.

Doctors also use the terms "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. 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 shape of tip can raise your risk of spinal headache.

Will I get a headache after an epidural? — Headaches don't happen very often after an epidural, but they can. For an epidural, 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. A spinal headache can happen after an epidural 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 that something else is not causing your headache. These can include imaging tests such as a CT scan or MRI. Imaging tests 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. Until then, lying down will help your headache. You can also take pain medicines like acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). Some people find that caffeine helps, especially if they are used to drinks with caffeine (such as coffee) every day. If you have nausea, your doctor can give you medicines to help with this.

If your headache does not start getting better after a day or so, your doctor might suggest a "blood patch." This treatment involves taking a small amount of your blood and injecting it into the area where the LP was done.

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

More on this topic

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

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

This topic retrieved from UpToDate on: Feb 02, 2024.
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