Spinal Headaches

Spinal headaches, also known as post-dural puncture headaches (PDPH), are a type of headache that occurs after a procedure that involves puncturing the dura mater, a protective layer surrounding the spinal cord.

Causes

• Dural puncture during a lumbar puncture (spinal tap) or epidural injection
• Accidental dural puncture during an epidural procedure
• Spontaneous cerebrospinal fluid (CSF) leak
• Trauma to the spine

Symptoms

• Severe, dull, or throbbing headache that worsens with standing or sitting and improves with lying down
• Headache typically occurs on both sides of the head, but can be unilateral
• Pain may radiate to the neck or arms
• Nausea and vomiting
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)
• Tinnitus (ringing in the ears)

Pathophysiology

The exact mechanism of spinal headaches is not fully understood, but it is thought that the leakage of cerebrospinal fluid (CSF) through the dural puncture site leads to a decrease in CSF pressure. This decrease in pressure causes the brain to sag, stretching the meninges and blood vessels, resulting in pain.

Diagnosis

• Medical history and physical examination
• Imaging studies, such as MRI or CT scans, to rule out other causes of headache
• CSF analysis to check for signs of infection or inflammation

Treatment

• Conservative management: bed rest, hydration, and pain relief medications
• Epidural blood patch (EBP): injection of a small amount of blood into the epidural space to seal the dural puncture site
• Caffeine and other medications to help alleviate symptoms

Prevention

• Using smaller needles during lumbar punctures or epidural injections
• Atraumatic needle design
• Proper technique during procedures

Complications

• Chronic headache
• CSF leak
• Meningitis or other infections
• Nerve damage or paralysis (rare)