Spinal Headache

A spinal headache, also known as a post-dural puncture headache (PDPH), is a type of headache that occurs after a procedure that involves puncturing the dura mater, which is the outermost membrane covering the brain and spinal cord.

Causes

The main cause of a spinal headache is the leakage of cerebrospinal fluid (CSF) from the puncture site. This can happen after procedures such as:

• Lumbar puncture (LP) or spinal tap
• Epidural injection or block
• Spinal anesthesia

Symptoms

The symptoms of a spinal headache may include:

• A dull, throbbing, or stabbing pain in the head
• Pain that worsens with standing or sitting and improves with lying down
• Nausea and vomiting
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)
• Neck stiffness

Diagnosis

The diagnosis of a spinal headache is typically made based on the patient's medical history and physical examination. Imaging studies such as MRI or CT scans may be ordered to rule out other causes of headache.

Treatment

The treatment for a spinal headache usually involves:

• Bed rest and hydration
• Pain management with over-the-counter or prescription medications
• Epidural blood patch, which involves injecting a small amount of the patient's blood into the epidural space to seal the puncture site

Prevention

To reduce the risk of developing a spinal headache, healthcare providers may use:

• Atraumatic needles, which cause less damage to the dura mater
• Smaller gauge needles, which result in smaller puncture sites
• Prophylactic epidural blood patches, which may be administered after certain procedures

Complications

If left untreated, a spinal headache can lead to complications such as:

• Subdural hematoma or other types of bleeding in the brain
• Meningitis or other infections
• Nerve damage or paralysis

Prognosis

The prognosis for spinal headache is generally good, with most patients experiencing complete resolution of symptoms within a few days to weeks. However, in some cases, the headache can persist for months or even years.