What is A Post-Lumbar Puncture Headache?

Risk Factors and Treatment of a Spinal Tap Headache

How a Headache May Develop After a Lumbar Puncture
Lumbar puncture in the Diagnosis of Increased Intracranial Hypertension. Dewald Kirsten/Gallo Images/Getty Images

Whether you underwent a lumbar puncture (also known as a spinal tap) during labor or for the diagnosis or treatment of a medical condition, you are not alone if you developed a headache—a common occurrence (but don't fret, it almost always goes away on its own).

What is a Post-Lumbar Puncture Headache?

A lumbar puncture is a procedure performed for a number of reasons, including testing the cerebrospinal fluid (the fluid that bathes and cushions your brain and spinal cord) for infection or inflammation, as in suspected meningitis or multiple sclerosis.

 

Lumbar punctures are also performed to administer medication into the cerebrospinal fluid (CSF), like antibiotics, chemotherapy, steroids, or anesthetics. For instance, during labor, it's common for a woman to undergo an epidural for pain relief. In this procedure, anesthetic is injected into the epidural space where CSF flows to numb the area below a woman's waist. Lumbar punctures may also be performed to measure the pressure of the CSF, as in idiopathic intracranial hypertension—a condition that causes a headache and vision changes.

About a third of patients develop a headache after a lumbar puncture (usually within 5 days) due to a puncture hole in the spinal canal, where the CSF leaks out. When the CSF leaks out, it can cause a headache that worsens when sitting upright or standing. This means that the head pain is alleviated when a person lies completely flat, but then returns (quite rapidly) when they lift their head up (as more CSF leaks out due to gravity).

The precise mechanism as to how a post-lumbar puncture headache develops is unclear. Some experts believe that CSF leakage causes a decrease in the volume and pressure of the CSF in the brain, preventing the brain from being cushioned by the skull. When a person lies down, the fluid can flow back into the brain (gravity) allowing it to be cushioned again and therefore relieving the headache.

Others believe that the low amount of CSF stimulate certain receptors in the brain that cause dilation of the brain arteries, leading to a headache.

Certain people are at a higher risk of developing a headache from a lumbar puncture. These risk factors include:

  • being female
  • between 31 and 50 years old
  • a previous history of a post lumbar puncture headache
  • procedural technique—orientation and size of the needle used to puncture into the thecal sac (which contains the CSF)

Pregnancy and being thin may also increase a person's risk of developing a post-lumbar puncture headache.

What Does a Post-Lumbar Puncture Headache Feel Like?

In addition to pain on both sides of the head that is positional—alleviated when lying horizontal and triggered when standing or sitting up—a post-lumbar puncture headache may be accompanied by other symptoms like:

  • neck stiffness
  • ringing in the ears
  • hearing changes
  • sensitivity to light
  • nausea

Treatment of a Post-Lumbar Puncture Headache

A post-lumbar puncture headache usually resolves on its own within a week but may take up to two weeks.

The good news is that most do go away on their own. Often simple measures like fluid intake, and pain-relievers (like opioids) can be helpful. Some doctors suggest caffeine too (although there is not really good scientific data to back this up.)

But if your headache persists, an epidural blood patch may be needed. This is a procedure in which the lumbar puncture hole is sealed with your blood. It offers immediate relief and is usually successful, although sometimes needs to be repeated.

A Word from Verywell

Getting a lumbar puncture can be unpleasant on its own, and a headache on top of it is no easy matter. But don't get discouraged, as your post-lumbar headache will go away either on its own or with a blood patch (which is a pretty simple procedure). 

 

Sources:

Ahmed, S.V., Jayawarna, C., & Jude, E. Post lumbar puncture headache: diagnosis and management. Postgraduate Medical Journal. 2006 Nov;82(973):713-16.

Halker, R.B. 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.

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