A spinal headache is a specific type of head pain that occurs following a procedure that enters the spinal canal, such as a lumbar puncture or the placement of an epidural. It is caused by a small leak of cerebrospinal fluid (CSF) through the puncture site in the dura mater, the membrane surrounding the brain and spinal cord. This leakage reduces the CSF volume and pressure, causing the brain to sag slightly when a person is upright. The distinct characteristic is its orthostatic nature: pain intensifies significantly within 15 minutes of sitting or standing and is relieved almost immediately upon lying flat. The pain is typically dull or throbbing, ranging from mild to debilitating, and may be accompanied by neck stiffness, nausea, or sensitivity to light.
Immediate Relief and Conservative Care
Management involves supportive, non-invasive measures intended to allow the puncture site to seal naturally. The most fundamental intervention is strict bed rest in a flat position. This immediately reduces the downward pull on the brain and minimizes CSF loss, providing profound symptomatic relief. This is highly recommended during the initial 24 to 48 hours.
Aggressive hydration is a cornerstone of conservative care. Increasing fluid intake is thought to help restore overall fluid volume, potentially aiding in CSF production. Drinking plenty of water and electrolyte-containing beverages is encouraged.
Caffeine can provide temporary symptom relief because it acts as a cerebral vasoconstrictor, narrowing the blood vessels in the brain. Since CSF loss causes these vessels to dilate, caffeine counteracts this, helping restore intracranial pressure balance. Oral caffeine is often recommended in doses of 300 to 500 milligrams daily, but total daily intake should generally not exceed 900 milligrams.
Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can be used to manage general discomfort. While these medications help alleviate pain, they do not address the underlying pressure imbalance caused by the fluid leak. These conservative steps are often sufficient for mild cases.
Indicators for Medical Consultation
Most spinal headaches resolve on their own within a few days to a week. If the headache persists for more than 48 hours despite consistent conservative measures, or if the pain is severe and debilitating, medical consultation is necessary. The administering physician or anesthesiologist should be contacted to discuss further treatment options.
Specific and concerning symptoms, often called “red flags,” demand immediate medical attention as they may indicate a serious complication. These include a high fever, a stiff neck, confusion or altered mental status, and any new focal neurological deficits. Examples are weakness in the limbs, difficulty speaking, or double vision. These symptoms could signal an infection, like meningitis, or a rare issue like a subdural hematoma, requiring urgent evaluation.
The Epidural Blood Patch Procedure
When a spinal headache is severe, persistent, or fails to respond to conservative care, the definitive treatment is the Epidural Blood Patch (EBP). This procedure is the standard for treating PDPH and is typically used when the headache lasts longer than 48 hours. The EBP involves injecting a small volume of the patient’s own blood into the epidural space near the original spinal puncture site.
The procedure is performed under sterile conditions, similar to receiving an epidural. Approximately 15 to 20 milliliters of blood is drawn from a vein and immediately injected into the epidural space. The mechanism works in two ways: the blood forms a clot that physically seals the hole in the dura mater, stopping the CSF leak. It also creates a temporary “tamponade” effect, increasing pressure to help restore normal intracranial pressure.
The success rate of the EBP is high, typically ranging from 85% to over 90% after the first attempt, often providing immediate relief. The procedure requires a short period of lying flat afterward to allow the clot to fully form and secure the seal. If the first patch is unsuccessful, a repeat EBP is a viable option.