What is a spinal headache?
A spinal headache can
occur as a result of a procedure such as a spinal tap (lumbar
puncture) or epidural block (such as that performed during a
woman's labor and delivery).
During these procedures, a needle is placed within the
fluid-filled space surrounding the spinal cord. This creates a
passage for the spinal fluid to leak out, changing the fluid
pressure of this space.
Because the design of spinal needles has been improved, spinal
headaches after a spinal tap or administration of spinal anesthesia
are rare. When epidural anesthetics are placed with a larger needle
than that used for spinal anesthetics, however, the likelihood of
headache is higher if the epidural needle should inadvertently pass
through the dura matter (covering of the spinal cord).
A spinal headache might occur up to five days after the
procedure is performed. Such a headache might be prevented with bed
rest after a procedure.
What causes a spinal headache?
Spinal headaches are
caused by a decrease in the pressure exerted by the cerebral spinal
fluid (CSF) around the patient's brain and spinal cord. When
a needle passes through the dura mater (the tough covering of the
spinal cord and brain), it creates a passage for spinal fluid to
leak out. If enough of the fluid leaks out, the patient might
experience a spinal headache.
What are the symptoms of a spinal headache?
The
spinal headache often is described as "a headache like no other."
Spinal headaches are much more severe when the patient is in an
upright position. They improve when the patient lies down.
How are spinal headaches treated?
The first course
of treatment for spinal headaches involves supplying adequate
hydration to try to increase cerebral spinal fluid (CSF) pressure.
Sometimes the patient can be hydrated with intravenous fluids
(fluids administered into the veins) or by drinking a beverage that
is high in caffeine. Caffeine makes blood vessels get smaller,
helping increase CSF pressure.
Another treatment might be strict bed rest for 24 to 48
hours.
If a patient develops a severe headache, the anesthesiologist
can administer a blood patch with the patient's blood to seal the
leak. To administer a blood patch, the anesthesiologist inserts a
needle into the same space as, or right next to, the area in which
the anesthetic was injected. The doctor then takes a small amount
of blood from the patient and injects it into the epidural space.
The blood clots and seals the hole that caused the leak.