Spinal headaches, also known as post-lumbar puncture headaches, are those headaches which a person suffers after undergoing a lumbar puncture (spinal tap) and spinal anesthesia. Almost half of the population which has undergone the above mentioned procedures suffers from a spinal headache after that particular procedure. In these procedures, the tough membrane which surrounds the spinal cord and the sacral nerve roots is punctured.
In the spinal tap or lumbar puncture, a small amount of cerebrospinal fluid is withdrawn from the spinal canal and this sample is sent for testing. In the spinal anesthesia procedure, the patient gets medication injected into their spinal canal. This is done in order to numb the nerves which are present in the lower half of the body. During any of these procedures, if there is a leakage of the spinal fluid via the puncture site, it may cause a headache; and this headache is known as spinal headache.
Spinal headaches usually don't need treatment as they tend to resolve on their own; however, if they last for more than 24 hours, then treatment is warranted.
Causes of Spinal Headache or Post-Lumbar Puncture Headache
Spinal headaches occur when the spinal fluid leaks through the puncture site in the membrane surrounding the spinal cord. Due to this leakage, the pressure which the spinal fluid exerts on the brain and the spinal cord decreases; and this results in a headache. Spinal headaches commonly occur within 12 to 24 hours after a spinal anesthesia or a spinal tap. In some cases, epidural anesthesia may also cause a spinal headache. Even though the epidural anesthetic is injected externally to the membrane around the spinal cord, but if the membrane is accidentally punctured, then it results in a spinal headache.
Risk Factors of Spinal Headache or Post-Lumbar Puncture Headache
- Women are at a higher risk for developing a spinal headache.
- Previous history of spinal headaches puts you at a higher risk for having spinal headaches in the future.
- Individuals aged between 19 and 30 years are more prone to develop spinal headaches.
- Individuals who undergo procedures where a large needle or multiple punctures are made in the membrane surrounding the spinal cord.
Signs and Symptoms of Spinal Headache or Post-Lumbar Puncture Headache
- The pain is felt as a dull and throbbing pain.
- The pain can be mild or can be very severe, so much so that a person is not able to function.
- The pain worsens upon sitting or standing and decreases or subsides upon lying down.
- Tinnitus (ringing in the ears)
- Photophobia, i.e. sensitivity to light.
- Neck stiffness.
Investigations for Spinal Headache or Post-Lumbar Puncture Headache
- Medical History and Physical Exam: Where the doctor will question you about the characteristics of the headache and ask about any recent procedures which you have undergone. A physical exam is also conducted.
- MRI or Magnetic Resonance Imaging: This test is done to exclude other causes for your headache. In this procedure, magnetic field and radio waves are employed to generate cross-sectional images of the brain.
Treatment for Spinal Headache or Post-Lumbar Puncture Headache
Conservative treatment is done first, which includes bed rest, lots of fluids, pain killers and caffeine. If the headache hasn't alleviated and still persists, then the following treatment methods are done:
- Epidural Blood Patch: This the first line of treatment done for persistent spinal headaches. In this procedure, a small amount of your blood is injected in the space over the site of the puncture hole. This leads to clot formation, which in turn seals the hole, thus reestablishing the normal spinal fluid pressure and relieving your headache.
- Caffeine given intravenously: Caffeine helps in relieving the spinal headaches by constricting the blood vessels present in the head. So, in this procedure, caffeine is released directly into the bloodstream intravenously to achieve relief from spinal headache.
- Epidural Saline: Doctors also inject saline or saltwater solution into the space externally to the membrane covering the spinal cord. This puts pressure on the site of the puncture and helps in stopping the leakage of cerebrospinal fluid. However, the saline solution gets absorbed rapidly by the body, so spinal headaches tend to recur after this method.