A spinal headache is a headache after a spinal or epidural procedure caused by spinal fluid leaking out of the puncture site into the surrounding tissues. It is a postural headache meaning it is worse with standing and better when laying down. It can be treated with bed rest, fluids, pain medication, caffeine, or a procedure called a blood patch. A spinal blood patch involves taking some of the patient’s own blood and using an epidural needle to place the blood against the puncture in the spinal sac to create a patch and stop the leak.
Spinal headaches are relatively uncommon with modern techniques. At one time about 5% of patients would get a spinal headache after a c-section. The incidence rate now is closer to 1% of patients will get a spinal headache after a spinal anesthetic or an epidural. When spinals are placed, a very thin needle is placed through the back into the spinal fluid and medicine is injected into the fluid to give pain relief. Occasionally spinal fluid can leak out from this puncture site into the tissues in the back. When an epidural is placed the spinal fluid can be inadvertently entered about 1% of the time, this is called a “wet tap”. Spinal fluid bathes the spinal cord and the brain. When the fluid leaks out it can cause the covering of the brain to sag onto the brain tissue causing a headache. This is not dangerous but it can be very uncomfortable.
When a bad headache occurs it can be diagnosed as a spinal headache by its characteristics. It occurs shortly after a spinal or epidural procedure. It is worse when standing up and better when laying down. Your obstetrician or anesthesiologist will be called to see you in such a case and treatment can be given.
Conservative treatment can be effective for some patients with spinal headache. Bed rest can help as gravity helps increase the amount of spinal fluid in and around the brain and relieves the headache. Pain medicine such as Tylenol, ibuprofen, or narcotics can also be helpful. Increasing fluid intake by drinking more or with an IV also is a good treatment for spinal headaches. Caffeine has been shown to be effective for most types of headaches and certainly for spinal headache. Coffee, soda, or tea can be consumed and this can help. IV caffeine can be given in some circumstances.
If conservative treatment does not relieve the headache a spinal blood patch can be used. This is a procedure similar to an epidural. Some of the patient’s own blood is drawn in the same manner that is used to check laboratory studies. An epidural needle is placed in the back and the patient’s own blood is then injected through the epidural needle over the puncture site in the spinal column. The blood clots and creates a patch over the leak. This tends to relieve the headache almost immediately.