Headache After a Lumbar Puncture

A Post-Dural Puncture Headache and Why It Happens

Why You May Get A Headache From a Lumbar Puncture
Why You May Get A Headache From a Lumbar Puncture. RapidEye/Getty Images

Headaches are the most common side effect of lumbar punctures (also called spinal taps). Although they are an unfortunate and often painful side effect of a common procedure, which in itself can be stress-inducing, they can be effectively treated by different methods.

Definition

A headache from a lumbar puncture, 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.

That said, the location of pain may vary, although typically occurs in the front of the head (usually directly behind the eyes) or in the back of the head. 

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

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

Cause

It may surprise you to know that experts do not know for certain what causes post-dural puncture headaches. That said, 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 that they are suspended in.

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 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 30mL) 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).

 

At-Risk Patients

Anyone can suffer from a headache following a lumbar puncture. 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.

Prevention

Needle Choice

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.

Bedrest Debunked

For a long time, it has been 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 that got up right away are no more likely to have a headache that those who stay in bed.

Treatment

First, Try Conservative Measures

Most headaches that follow lumbar punctures are mild and tend to resolve on their own. They also tend to respond well to painkillers, including opioids, if necessary.

This should take care of most of the pain while waiting for the headache to go away on its own. 

In addition, studies reveal that other drugs may be useful too in treating a headache after a lumbar puncture like the anticonvulsant Neurontin (gabapentin), hydrocortisone ( a type of steroid), and a lung medication called theophylline. 

Finally, intravenous or oral caffeine 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 is probably the next thing that will be tried if the 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, 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. The good news is that most will respond quickly to painkillers or on its 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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