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A spinal headache is a highly intense type of headache that arises when there’s a decrease in the level of cerebrospinal fluid (CSF) enveloping the brain. This reduction can occur following procedures like a spinal tap (lumbar puncture) or due to the leakage of CSF caused by tears or cysts in the protective meninges covering the spinal cord. The CSF layer serves to safeguard the brain and spinal cord, providing cushioning against abrupt movements and supplying essential nutrients.
A spinal tap involves the extraction of a small CSF sample from the spinal canal, while spinal anesthesia entails injecting medication into the same canal to numb lower body nerves. If spinal fluid leaks through the puncture site, it can trigger the onset of a spinal headache. These headaches are also termed post–dural puncture headaches and are commonly associated with spinal procedures. They may alternately be referred to as epidural headaches or low–pressure headaches.
In most cases, spinal headaches tend to subside on their own without necessitating treatment. However, instances of severe spinal headaches that persist for 24 hours or more might require medical attention. These headaches can be particularly distressing due to the decreased CSF cushioning around vital neurological structures.
Symptoms
Symptoms of a spinal headache consist of:
- A dull, throbbing pain that ranges in severity from barely perceptible to excruciating
- Pain that usually increases when you sit up or stand and reduces or disappears when you lie down.
Spinal headaches frequently come with:
- Dizziness
- Nausea
- Vomiting
- Seizures
- Stiff neck
- Neck pain
- Tinnitus
- Eye problem (double or blurred vision)
- Losing your hearing
- Photophobia or being sensitive to light.
If you experience a headache following a spinal tap or spinal anesthetic, let your doctor know right away, especially if it grows worse as you sit up or stand.
Causes
Spinal headaches result from the leakage of spinal fluid due to a puncture in the dura mater, the spinal cord’s protective membrane. This leakage reduces the pressure of spinal fluid on the brain and spinal cord, leading to a headache. These headaches usually manifest within 48 to 72 hours following a spinal tap or spinal anesthesia. In some cases, epidural anesthesia can also cause spinal headaches if it accidentally punctures the surrounding membrane, despite being administered just outside it.
Risk factors
The following are risk factors for spine headaches:
- Age: Being between 18 and 30 years old.
- Gender: Being female.
- Pregnancy: Being pregnant.
- Headache History: Having a history of frequent headaches.
- Medical Procedures: Undergoing procedures that use larger needles or involve multiple punctures in the membrane around the spinal cord.
- Body Size: Having a smaller body mass.
Diagnosis
When seeking medical attention for a spinal headache, the healthcare provider will inquire about the symptoms of your headache and conduct a physical examination. It’s important to make sure you communicate any recent medical procedures you’ve undergone, particularly spinal taps or spinal anesthesia. In certain situations, the healthcare provider might suggest undergoing magnetic resonance imaging (MRI) to rule out other possible causes of your headache. This imaging procedure employs a combination of magnetic fields and radio waves to create detailed cross–sectional images of the brain.
Treatment
The treatment for spinal headaches starts conservatively. Your healthcare provider may advise bed rest, increased fluid intake, consumption of caffeine, and the use of oral pain relievers, all while lying down in a flat position.
If your headache doesn’t improve within 24 hours, your provider might recommend an epidural blood patch. This involves injecting a small amount of your blood into the space over the puncture hole. This often leads to the formation of a clot that seals the hole, restoring normal spinal fluid pressure and relieving the headache. The epidural blood patch is the standard approach for persistent spinal headaches that don’t resolve on their own.
