Spinal Headaches

Overview

What is a spinal headache?

A spinal headache is a very intense headache. It occurs when cerebrospinal fluid (spinal fluid that surrounds and cushions the brain) leaks out of the meninges (tissue that surrounds the brain and spinal cord).

This leakage reduces the amount of fluid around the brain. The leakage can cause the tissues and nerves that support the brain to stretch painfully.

Spinal headaches typically last from a few hours to a few days. These headaches feel better when a person is lying down and get worse when sitting up or standing. They are also known as post-dural puncture headaches and epidural headaches.

How common is a spinal headache?

Spinal headaches occur in about 32 percent of people who receive a spinal tap.

Symptoms and Causes

What causes a spinal headache?

The most common cause of a spinal headache is a puncture (hole) created during a procedure called a spinal tap or lumbar puncture. Doctors use this procedure to diagnose illness and deliver anesthesia, such as when pregnant women have an epidural during childbirth.

Area of the spine where spinal tap takes place and close-up of needle into spinal canal.

Area of lower spine where spinal tap is taken and close-up of needle in the spinal canal.

During the lumbar puncture, a doctor inserts a needle into the spinal canal in the lower back to deliver anesthesia or withdraw a sample of cerebrospinal spinal fluid. Sometimes, spinal fluid leaks out of the tiny hole created by the needle. The loss of fluid reduces the fluid balance surrounding the brain, which causes the brain to sag downward. The surrounding nerves and tissues become stretched, which results in the headache.

Other conditions can cause spinal fluid leaks that lead to spinal headaches. These problems include a ruptured (burst) cyst on the spinal cord and a head or face injury such as a fractured skull.

What are the signs and symptoms of a spinal headache?

A spinal headache develops within 5 days after a spinal tap. Usually, it occurs within 1 to 2 days after the spinal tap. Symptoms of a spinal headache include:

  • Intense dull or throbbing headache that starts in the front or back of the head
  • Headache pain that increases when sitting or standing
  • Headache pain worsens when coughing, sneezing or straining
  • Neck pain
  • Stiff neck
  • Nausea, vomiting
  • Sensitivity to bright light

Diagnosis and Tests

How is a spinal headache diagnosed?

A doctor diagnoses a spinal headache based on your history and symptoms. If you have had a spinal tap within 14 days, diagnosis is often obvious. In that case, tests are usually not needed.

In people who have not had a spinal tap, doctors typically use imaging tests called magnetic resonance imaging (MRI) to diagnose the source of the headache. These tests enable the doctor to see the brain and spinal cord to look for signs of leaking spinal fluids.

Management and Treatment

How is a spinal headache managed or treated?

To manage most spinal headaches, doctors recommend:

  • Lying down
  • Drinking lots of fluids, including drinks containing caffeine (coffee, tea, and some soft drinks)
  • Taking over-the-counter pain relievers such as ibuprofen

Sometimes, these measures do not relieve the pain. If a spinal headache lasts more than a few days, your doctor may recommend a procedure called an epidural blood patch. During this procedure, the doctor injects a small amount of your own blood over the hole. When the blood clots, it seals the hole.

In very rare cases, doctors use surgery to seal the hole where spinal fluid is leaking.

What complications are associated with a spinal headache?

Untreated spinal headaches can cause life-threatening complications including subdural hematoma (bleeding in the skull that puts increased pressure on the brain) and seizures. Other rare complications include infection and bleeding in the back.

Prevention

Can a spinal headache be prevented?

Doctors can reduce the risk of causing a spinal headache by performing a spinal tap using a small needle called a non-cutting needle.

Avoiding a spinal tap also lowers the risk of a spinal headache.

What are the risk factors for a spinal headache?

People at higher risk for a spinal headache include those who:

  • Are between 18-30 years old
  • Are pregnant
  • Have a low body mass index

Outlook / Prognosis

What is the prognosis (outlook) for people with a spinal headache?

About 85 percent of all spinal headaches get better on their own without treatment. The headaches disappear very quickly in up to 70 percent of people who receive a blood patch.

Living With

When should I call the doctor?

Contact your doctor if you experience a severe headache after a spinal tap. Get immediate medical attention if you experience difficulty urinating or lose feeling in your back or legs.

What questions should I ask my doctor?

If you suspect you have a spinal headache, you may want to ask your doctor:

  • What is causing this headache?
  • How long will it last?
  • What are the risks and side effects of treatment?

When can I go back to my regular activities?

Most people with a spinal headache go back to their usual activities as soon as the headache goes away.

Last reviewed by a Cleveland Clinic medical professional on 09/24/2018.

References

  • International Classification of Headache Disorders 3rd Edition. 7.2.1 Post-dural puncture headache. (https://www.ichd-3.org/7-headache-attributed-to-non-vascular-intracranial-disorder/7-2-headache-attributed-to-low-cerebrospinal-fluid-pressure/7-2-1-post-dural-puncture-headache/) Accessed 9/24/2018.
  • Merck Manual. Low-Pressure Headache. (https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/headaches/low-pressure-headache) Accessed 8/1/2018.
  • NHS Trust. Headache after an epidural or spinal anaesthetic. (https://www.pat.nhs.uk/downloads/New%20NCA%20Leaflets/Anaesthetics/225%20-%20Headache%20after%20an%20Epidural%20or%20Spinal%20Anaesthetic.pdf) Accessed 8/1/2018.
  • Ahmed SV, Jayawarna, Jude E. Post lumbar puncture headache: diagnosis and management. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660496/) Postgrad Med J 2006; Nov, 82(973):713-716.
  • Center for Advancing Health. Caffeine Can Ease a Spinal Tap Headache. (http://www.cfah.org/hbns/2011/caffeine-can-ease-a-spinal-tap-headache) Accessed 8/1/2018.

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