Spinal Headache

Symptoms

A spinal headache (or low pressure headache, or post-lumbar puncture headache) is usually experienced as a persistent headache, often with neck stiffness, that is worsened by remaining upright and markedly improved by lying flat or even elevating the legs and body above the head height.

What causes it?

This headache is due to low pressure in the (cerebrospinal) fluid that surrounds the brain. Because of this reduced pressure, the brain sags slightly and this pulls on the membranes that cover and hold the brain in place (meninges) causing pain in the head and neck. Lying down reduces the stretching of these membranes and therefore reduces the degree of pain.

The most common reason for getting a headache of this sort is undergoing a spinal tap (lumbar puncture) during which fluid is removed with a needle from the spinal canal in the lower back. In about 20% of cases, after the procedure is completed, the fluid continues to very slowly leak out of the spinal canal, and leads to the symptoms described above.

Lumbar Puncture Anatomy

Rarely, patients may have these symptoms develop spontaneously (idiopathic intracranial hypotension) due to the development of a spontaneous leak somewhere along the spinal canal or sometimes after significant body trauma, as occurs during a fall from a height or a motor vehicle accident. It could also begin to leak, usually after head trauma, from the cribriform plate, a thin bone that separates the sinuses from the cerebrospinal fluid of the brain.

How is it treated?

Treatment of spinal headache depends on the duration of symptoms and the cause. If the cause is a spinal tap, then having the patient take in caffeine, drink plenty of fluids, and remain flat usually leads to the spontaneous 'sealing' of the hole created by the spinal needle and the headache goes away. If this is not sufficient, other treatments include intravenous caffeine or sumatriptan (Imitrex, a vasoconstricting medication usually used to treat migraines).

If the above conservative therapy isn't effective, a patient can undergo an epidural blood patch. This involves drawing blood from the patient and then having it reinjected into the epidural space of the back, where the cerebrospinal fluid was originally taken from. This is essentially using blood, which clots where it is placed, to seal the hole from which the fluid was leaking. This is usually very effective and headache symptoms can resolve within an hour of the procedure.

The treatment of other causes of spinal headache is beyond the scope of this web page, but initially will involve tests to determine if a leak is present, followed by methods (often including blood patches) to treat them if found.



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