A spinal headache, also known as a post-dural puncture headache (PDPH), is a specific type of headache that can occur after medical procedures involving the spine. These procedures often include lumbar punctures, also called spinal taps, and the administration of epidural or spinal anesthesia.
What is a Spinal Headache?
A spinal headache develops when there is a leak of cerebrospinal fluid (CSF) from the dura mater, the protective membrane. This leakage leads to a decrease in CSF pressure around the brain, which can cause the brain to sag within the skull. The characteristic symptom is a headache that worsens significantly when sitting or standing upright and improves when lying flat.
The onset of a spinal headache usually occurs within 24 to 48 hours following the procedure, though sometimes delayed. Along with the positional head pain, individuals might experience accompanying symptoms, including:
Neck stiffness
Nausea
Vomiting
Dizziness
Sensitivity to light (photophobia)
Sensitivity to sound (phonophobia)
Changes in hearing or vision, such as ringing in the ears (tinnitus) or blurred vision
How Long Do Spinal Headaches Typically Last?
Spinal headaches are generally self-limiting, resolving within days to a week. Many individuals find their symptoms improve within two to three days, while over two-thirds of cases resolve within one to two weeks. However, some spinal headaches can persist for several weeks, with up to 85% of cases resolving within six weeks. Individual experiences vary depending on several factors.
The size and type of needle used during the procedure can influence duration. Smaller gauge, non-cutting needles tend to create a smaller hole, closing more quickly and reducing symptom duration. Conversely, the use of larger needles or multiple puncture attempts can increase the risk of a more substantial CSF leak, potentially prolonging the headache.
Age can also play a role, as younger patients are more susceptible and may experience symptoms for longer. Postpartum women are also at a higher risk of developing spinal headaches, which might be more severe or last longer. Adequate rest (especially lying flat) and consistent hydration can support the natural healing process of the CSF leak, potentially leading to faster resolution.
Treatment and Management
Initial management for a spinal headache typically involves conservative measures aimed at alleviating symptoms and supporting natural healing. Lying flat helps reduce positional pain by minimizing gravitational pull on the brain. Drinking fluids can help restore CSF volume and pressure. Many healthcare providers suggest consuming caffeine, as it can constrict blood vessels and temporarily increase CSF production, offering relief. Over-the-counter pain relievers can manage headache pain.
If conservative measures do not provide sufficient relief or if the headache is severe, medical interventions may be considered. The most effective treatment for a persistent or debilitating spinal headache is an epidural blood patch. This procedure involves injecting a small amount of the patient’s blood into the epidural space at or near the CSF leak. The injected blood forms a clot that seals the hole in the dura mater, stopping CSF leakage and restoring normal pressure.
When to Consult a Doctor
Consult a healthcare provider if a spinal headache does not improve or worsens after several days of conservative management. Medical attention is also warranted if the headache is debilitating or significantly interferes with daily activities.
Immediate medical consultation is important if new or worsening neurological symptoms develop, such as:
Fever
Stiff neck unrelated to the headache itself
Confusion
Weakness
Numbness
Vision changes, such as double vision
Difficulty speaking
Difficulty urinating
Loss of sensation in the back or legs