Overview
Spinal headaches are a type of headache that occurs after a spinal tap or spinal anesthesia. During these procedures, a puncture is made in the membrane surrounding the spinal cord, and spinal fluid may leak through the tiny puncture site, leading to a headache. Symptoms of spinal headaches may include dull, throbbing pain that worsens when sitting up or standing, dizziness, ringing in the ears, hearing loss, blurred vision, nausea, and neck pain. Most spinal headaches resolve on their own within 48-72 hours, but severe cases may require treatment.
Understanding the disease
Symptoms
Spinal headache symptoms include:
- Dull, throbbing pain that varies in intensity from mild to very severe
- Pain that typically gets worse when you sit up or stand and decreases or goes away when you lie down
- Dizziness
- Ringing in the ears (tinnitus)
- Hearing loss
- Blurred or double vision
- Sensitivity to light (photophobia)
- Nausea and vomiting
- Neck pain or stiffness
- Seizures These symptoms typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia.
Risk Factors
Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache. Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia. Risk factors for developing spinal headaches include undergoing a spinal tap or spinal anesthesia and having a history of spinal headaches or other headaches.
Development
Spinal headaches develop as a complication of spinal taps or spinal anesthesia, which requires a puncture of the membrane surrounding the spinal cord and nerve roots in the lower spine. During these procedures, if spinal fluid leaks through the puncture site, a spinal headache may occur. The leakage of spinal fluid decreases the pressure exerted on the brain and spinal cord, leading to a headache. Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia.
Assessment and Diagnosis
Triage
If spinal headaches are suspected, you should seek medical advice from your doctor if you experience the following symptoms:
- Dull, throbbing pain that varies in intensity from mild to very severe
- The headache appears within 48 to 72 hours after a spinal tap or spinal anesthesia
- The headache lasts for 24 hours or more
- You have risk factors such as being between the ages of 18 and 30, female, pregnant, with a history of frequent headaches, or have undergone procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord. Remember that most spinal headaches resolve on their own with no treatment, but severe cases may need treatment.
Diagnosis
To diagnose spinal headaches, the healthcare provider will start by asking questions about your headache and conducting a physical exam. It is important to mention any recent procedures, especially spinal taps or spinal anesthesia. Sometimes, the provider may recommend magnetic resonance imaging (MRI) to rule out other causes of your headache. The MRI creates cross-sectional images of the brain using a magnetic field and radio waves. If you have unusual or complicated headaches, your doctor may also order imaging tests like computerized tomography (CT) scans to rule out serious causes of head pain, such as a tumor.
Management and Treatment
Complications
Spinal headaches, also known as post-dural puncture headaches, typically resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment. Some potential complications of spinal headaches include:
- Persistent headache: In rare cases, spinal headaches may become chronic and last for several days or even weeks.
- Hydrocephalus: A rare but potential complication of spinal headaches is the development of hydrocephalus, a condition characterized by an accumulation of cerebrospinal fluid in the brain.
- Infection: Although uncommon, there is a small risk of infection at the puncture site, which may require treatment with antibiotics.
- Nerve damage: In severe cases, prolonged spinal headaches or multiple episodes of headaches may lead to nerve damage or spinal cord injury, causing symptoms months or years later. It is essential to consult a healthcare provider if you develop a headache after a spinal tap or spinal anesthesia, especially if the headache gets worse when you sit up or stand. Proper diagnosis and management can help minimize potential complications.
Prevention
Spinal headaches can be prevented or managed by following certain precautions:
- Be cautious during medical procedures: When undergoing a spinal tap or spinal anesthesia, ensure that the medical professional performing the procedure is experienced and takes necessary precautions to avoid puncturing the membrane surrounding the spinal cord.
- Maintain proper hydration: Drink plenty of fluids before, during, and after the procedure to help minimize the risk of spinal headaches.
- Avoid strenuous activities: Refrain from strenuous physical activities, such as heavy lifting or intense exercise, after the procedure, as these may increase the risk of spinal headaches.
- Use medication as directed: If you experience a spinal headache, take medication as prescribed by your healthcare provider to alleviate the pain and manage symptoms. While these measures can help prevent spinal headaches, it is essential to consult your healthcare provider for personalized advice and recommendations based on your medical history and specific situation.
Treatment
Treatment for spinal headaches begins conservatively. Your provider may recommend getting bed rest, drinking plenty of fluids, consuming caffeine, and taking oral pain relievers. If your headache hasn't improved within 24 hours, your provider might suggest an epidural blood patch. This involves injecting a small amount of your blood into the space over the puncture hole, which will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache.
Preparing for medical consultation
To prepare for an appointment for spinal headaches, you should:
- Note any pre-appointment restrictions: When you make the appointment, ask if there's anything you need to do in advance, such as restricting your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment.
- List your key medical information, such as past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
- Make a list of all medications, vitamins, and supplements you're taking.
- Take a family member or friend along, if possible, as they may remember something you missed or forgot.
- Write down questions to ask your healthcare provider, such as:
- What is likely causing my symptoms or condition?
- Are there other causes?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What alternatives are there to the approach you're suggesting?
- How can I best manage other health conditions I have?
- Are there any restrictions I need to follow?
- Should I see a specialist? Remember to be prepared and bring the necessary information to your appointment to ensure a productive visit with your healthcare provider.