Have you ever had a headache, pulsing right behind your eyes, and reaching straight through to the back of your head after a spinal procedure? Then you might have experienced or understand what is feels like to have a spinal headache. They generally originate in the hospital, after having spinal anesthesia or a spinal tap. Spinal taps are often used to diagnose and stage blood cancers because they can determine if your cancer has spread to the cerebrospinal fluid that surrounds the brain and spinal column.
There can be other causes of spinal headaches where cerebrospinal fluid (CSF) is leaking, like an injury that causes a tear or a burst cyst. But, the most common reason for the onset of a spinal headache is a spinal procedure.
What is a spinal tap?
A spinal tap, also known as a lumbar puncture, is a procedure where a needle is inserted between two vertebrae in your spinal column in order to withdraw a sample of spinal fluid from your spinal canal. This is done by puncturing the dura, a membrane that surrounds the spinal column. A diagnostic tool, lumbar punctures are used to evaluate central nervous system (CNS) disorders such as meningitis, multiple sclerosis, and Guillain-Barre syndrome, as well as cancers of the brain and spinal cord or cancers that have spread to those locations.
Why spinal headaches happen
A spinal headache is the most common after effect of a lumbar puncture, occurring in nearly 40% of people who undergo lumbar (or dural) punctures, or who have spinal anesthesia. Also known as a post-dural or a low-pressure headache, it may occur when there is a leak of CSF from the puncture site.2,3 Leakage of fluid can cause an adverse change in the pressure of the spinal fluid on the brain and the spinal cord. The fluid normally serves as a cushion that supports and reduces pressure on the brain. Leaks frequently lead to pain.
Sometimes referred to as a postural or a positional headache, you can often reduce discomfort from spinal headaches by lying down, which equalizes the pressure and generally makes you feel better. Standing or sitting can cause dizziness, nausea, and a stiff neck.1
Spinal anesthesia, often referred to as a spinal block, uses the same kind of needle puncture as the lumbar procedure to administer medicine. It flows through a catheter in the back, into the spinal fluid in the epidural space around your spinal cord.1 If the CSF leaks, it may not replenish itself fast enough, and a decreased volume can cause “sagging” where pressure on the brain was previously equalized.
The onset of spinal headaches can occur within hours, or as long as several days after undergoing one of these procedures. Most resolve on their own and don’t require treatment. Symptoms can additionally include ringing in the ears and vision problems, but bed rest, hydration and caffeine generally help.
If you are young, small, and female, you are at increased risk for developing a spinal headache after a procedure. Using newer, smaller, noncutting needles can reduce the risk of developing a spinal headache.3
Spinal headache treatment
Treatment for spinal or low-pressure headaches is generally conservative. Since they tend to go away quickly doctors usually recommend over the counter painkillers and drinking fluids. IV hydration and caffeine are additional options your doctor can consider if symptoms don’t resolve quickly.
An epidural blood patch can also slow a CSF leak. A doctor can inject a small amount of clotted blood into the epidural space in the lower back and that will serve as a “patch” to clot and seal the hole. This procedure helps to normalize the pressure and should eliminate the headache. Surgical repair is rarely required.1,4
Spinal Headaches. Mayo Clinic Website. Published April 03, 2015 . https://www.mayoclinic.org/diseases-conditions/spinal-headaches/symptoms-causes/syc-20377913. Accessed online March 11, 2018.
Stachowiak, J. Spinal Headache After a Lumbar Puncture. Updated September 16, 2017. https://www.verywell.com/headache-as-a-side-effect-of-lumbar-punctures-2440694. Accessed online March 10, 2018.
Silberstein, S. Post–Lumbar Puncture and Other Low–Pressure Headaches. Merck Manual Professional Edition. Updated July 2016. https://www.merckmanuals.com/professional/neurologicdisorders/headache/post%E2%80%93lumbar-puncture-and-other-low%E2%80%93pressure-headaches. Accessed online March 10, 2018.
Silberstein, S. Low Pressure Headache. Merck Manual Consumer Website. https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve disorders/headaches/low-pressure-headache. Accessed online March 10, 2018.