Spinal Headache After a Lumbar Puncture

What a Post-Dural Puncture Headache Is and Why It Happens

Why You May Get A Headache From a Lumbar Puncture
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Spinal headaches are the most common side effect of lumbar punctures (also called spinal taps). Anyone can suffer from one. However, it seems to be most likely if you are female, between the ages of 31 and 50, and have a history of headaches after spinal taps. The good news is that most of these types of spinal headaches are mild and they can be effectively treated.

What Is a Post-Dural Puncture Headache?

A headache from a lumbar puncture, which is called a post-dural puncture headache, occurs within five days of the procedure.

The pain is fairly distinct in that it's much worse when sitting or standing and eased when lying down. The location of the pain may vary, although it typically occurs in the front of the head (usually directly behind the eyes) or in the back of the head. 

Other symptoms that are sometimes associated with this type of a spinal headache include:

  • Ringing in the ears 
  • Hearing problems
  • Neck stiffness
  • Nausea
  • Dizziness
  • Vision problems

Pinning Down the Cause

It may surprise you that experts do not know for certain what causes post-dural puncture headaches. But there are some theories. 

When a lumbar puncture is performed, the doctor must puncture the dura, the membrane that contains the brain and spinal cord, as well as the cerebrospinal fluid (CSF) in which they are suspended. One theory is that if there is continued leakage of cerebrospinal fluid, it cannot be replenished fast enough. This causes the brain to “sag” in place, stretching pain-sensitive structures.

Another possible cause could be the dilation (widening) of the veins in the brain after the procedure.

Interestingly, according to a study in JAMA Neurology, removing a high volume of CSF (more than 30 mL) led to a greater risk of the patient developing a headache right after the procedure but did not increase the risk of a headache at 24-hour follow-up.

This suggests that the biology behind a headache may differ depending on when it develops (right after the procedure versus a day later). 

Preventing the Problem

A couple of studies have shown that using smaller needles (rather than larger-bore needles) or “atraumatic” needles (rather than conventional “cutting” needles) results in a much lower incidence of post-lumbar puncture headache. The only potential drawback of the smaller needles or atraumatic needles is that they may require greater expertise to insert, meaning that there may have to be more attempts to successfully get a sample.

It's worth noting that for a long time, it was recommended that people stay in bed for a period of time following a lumbar puncture, lying flat on their backs. A review of several studies has shown that this really doesn’t seem to have an effect at all and that patients who get up right away are no more likely to have a spinal headache than those who stay in bed.

Top Treatments

Most spinal headaches that follow lumbar punctures are mild and tend to resolve on their own. But these are some common forms of treatment.

  • Painkillers: They tend to respond well to painkillers, including opioids, if necessary.
  • Miscellaneous Meds: Other drugs may be useful like the anticonvulsant Neurontin (gabapentin), hydrocortisone (a type of steroid), and a lung medication called theophylline. 
  • Caffeine: Intravenous or oral caffeine is thought to work by causing the vascular system in the brain to constrict. This method seems to have very few side effects and in addition to treating a post-dural headache, it may also help prevent one. 
  • Epidural Blood Patch: This may be tried if the spinal headache pain lasts more than 24 hours and is so severe that painkillers do not provide relief. It's shown to be successful in up to 98 percent of patients, although it occasionally needs to be done twice. The procedure is simple and is performed by a doctor. Blood is taken out of a vein and injected into your epidural space (the space outside the dura). A small amount of local anesthesia will be used and you will be asked to rest for about 30 minutes, and then stand up. Essentially, this procedure works by “plugging the leak” in your dura.

    A Word From Verywell

    While the majority of these post-dural puncture headaches are mild, some can be pretty severe. Fortunately, most will respond quickly to painkillers or on their own (although it can take several days). 

    In very rare cases, a post-dural puncture headache indicates that something more serious is going on in the brain like a bleed or an infection. This is why it's important to alert your doctor if you are experiencing such a headache. 

    Sources:

    Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015 Jul 15;(7):CD007887.

    Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI, Crum BA, Dodick DW. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist. 2007 Sep;13(5):323-7.

    Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

    Monserrate AE et al. Factors associated with the onset and persistence of post-lumbar puncture headache. JAMA Neurol. 2015 Mar;72(3):325-32.

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