Spinal headache occurs as a complication in people who undergo spinal anesthesia, epidural block, or lumbar puncture, this is also known as spinal tap headaches. This is common in around 50% of the people who undergo the procedure but the pain may vary in intensity, person to person beginning in the back of head or forehead, sometimes spreading in the whole head.
Symptoms of spinal headache
- A dull, throbbing headache
- Dizziness and nausea
- Tinnitus
- Hearing loss
- Blurred or double vision (diplopia)
- Neck stiffness
The Spinal headache may start within 1 to 5 days of the procedure, lasting for up to 24 hours. In most cases, the headache may go away within 24 hours without any sort of treatment. Headache worsens upon standing up or sitting down whereas the patient may feel relief on lying down.
Causes of spinal headache
Spinal headache occurs due to a decrease in pressure exerted by the spinal fluid on the brain and spinal cord when a spinal tap, epidural block, or lumbar puncture is performed.
A spinal tap involves withdrawing a small amount of cerebrospinal fluid from the spinal cord. However, during spinal anesthesia, anesthetic medication is injected into your spinal cord to block all the sensations from the lower part of your body. In both cases, a puncture hole is created which allows a small amount of spinal fluid to leak through it. This causes changes in pressure and thus a spinal headache.
Complications of spinal headache
A spinal tap is done under septic conditions by an experienced physician and rarely causes any complication, but sometimes the spinal tap can complicate to develop some of these conditions:
- A subdural hematoma
- An infection like meningitis
- Bleeding sometimes leading to a hemorrhage
Risk factors
According to a study:
- Females are more prone to having spinal headaches as compared to men
- A four-fold increased incidence was seen in patients who have been suffering from tension headaches previously
- Patients who had repeated puncture attempts also are at greater risk of having spinal headaches
- People with a smaller body mass-developed spinal headaches after the procedure
How to prevent a spinal headache?
- Proper bed rest is very helpful in the prevention of a headache episode after the procedure
- Insertion of the needle should be kept parallel to the long axis of the spine to reduce the risk
- Completely discouraging the practice of reinsertion of the stylet is also very helpful
- Use of atraumatic needle allows less amount of leakage of spinal fluid thus preventing a headache
Management of spinal headache
Spinal headache is mostly treated with a complementary approach but proper diagnosis and confirmation are required before the beginning of treatment.
Diagnosis:
If you go to a physician with a complaint of a spinal headache, he might inquire about any recent procedures you must’ve had, like a lumbar puncture, spinal tap, or an epidural block. He might also suggest getting an MRI (Magnetic Resonance Imaging) done to rule out any other probable cause of headache.
Treatment:
The treatment goes step by step and according to the symptoms.
- Hydration: The first step involves keeping hydrated. To raise the pressure exerted by cerebrospinal fluid (CSF). However, if the patient is unable to consume a lot of fluid by the oral route, he is given intravenous fluids.
- Caffeine: Your physician might suggest taking a strong coffee or any other drink high in caffeine.
- Complete bed rest: Bed rest for 24 to 48 hours is mandatory.
- Analgesics: Sometimes analgesics are also prescribed to relieve the pain.
Epidural blood patch for spinal headache:
If your symptoms do not resolve in 48 hours, your physician might suggest getting an epidural blood patch. The process involves injecting a small amount of your own blood into your spinal cord over the puncture hole to seal it. The blood forms a clot and does not let more CSF flow out. This restores the normal pressure of spinal fluid in a few hours.
When to consult a doctor?
The headache is usually benign and is just a response to low pressure. However, if a spinal tap headache does not go away in a day or more, has other symptoms like vomiting, fever, signs of toxicity, or dizziness, it needs immediate medical attention.
FAQ
How painful is a spinal headache?
Spinal headache is a dull and throbbing pain that can vary from mild to debilitating in intensity. The pain usually aggravates upon sitting or standing up but gets better when you lie down.
Can spinal headaches go away themselves?
Yes, it resolves within 24 to 48 hours of its onset. However, if the headache does not go away and symptoms aggravate you must consult a physician.
What is a blood patch for spinal headache?
A small amount of your blood is withdrawn to seal the puncture hole created during a spinal tap in your spinal cord the blood forms a clot and stops more cerebrospinal fluid from leaking out.
When should I go to ER for spinal headache?
If your spinal headache does not resolve within 48 hours of its onset and your symptoms are aggravating with time. You should go to the ER as soon as possible.
