What is a Spinal Headache?

A spinal headache is a headache which occurs after the membrane which surrounds the spinal cord has been punctured, as occurs in spinal anesthesia and lumbar punctures. The headache is caused by the leaking of spinal fluid through the puncture site, and usually onsets between 12 hours and a day after the procedure which involved a puncture. Spinal headaches generally resolve on their own, but they can be painful and uncomfortable, leading many patients to seek treatment to relieve their pain.

Classically, a spinal headache manifests when a patient changes position, moving from a prone position to a standing or sitting one. Patients can experience a ringing sensation in their ears, dizziness, disruptions of the visual field, and nausea. When they lie down, symptoms are usually eased, and the treatment recommendation for a spinal headache is often to simply lie down and allow the headache to resolve as the puncture site heals over and pressure is restored.

Patients can also be provided with analgesics to ease the pain, and they may be given fluids intravenously or by mouth in an attempt to elevate their pressure and resolve the headache. Caffeine can also be administered to contract the blood vessels, which will increase pressure. Spinal headaches can also be treated with a blood patch, in which a small amount of the patient's blood is carefully injected into the puncture site to create a clot which seals it off, preventing the leakage of fluid.

Also known as a Post Dural Puncture Headache (PDPH), a spinal headache is a well known side effect of procedures in which the dura is punctured. Special care is taken to reduce the risk of developing a spinal headache, including using small needles for such punctures to minimize leakage of spinal fluid. Frequency of spinal headaches varies, with up to 25% of patients developing a headache after a puncture of the dura. The condition is more common in people who have a history of headaches.

Epidural anesthesia can also lead to a spinal headache, although the dura is not punctured during this anesthetic procedure. If the anesthesiologist accidentally nicks or punctures the dura, allowing spinal fluid to leak, a headache can appear. Patients should report headaches and other side effects after procedures involving the spinal cord so that their doctors can be aware of them, and headaches which persist for more than 24 hours should be treated more aggressively.