Spinal Headaches

What is a spinal headache?

A spinal headache is an intense headache that happens when the amount of cerebrospinal fluid (CSF) around your brain decreases. It can result from a spinal tap (lumbar puncture) or if CSF leaks out due to a cyst or tear in the meninges that cover your spinal cord.

Your brain and spinal cord have a surrounding protective layer of CSF. It contains nutrients that your brain can use. The CSF layer also supports and cushions your brain and spinal cord from sudden movements.

A leakage of CSF reduces the amount of fluid around your brain. The leakage can cause the tissues and nerves that support your brain to stretch, resulting in headache pain.

Spinal headaches are also known by the following names:

• Post-dural puncture headaches.
• Epidural headaches.
• Low-pressure headaches.

How common are spinal headaches?

Studies show that a spinal headache develops in approximately 10% to 40% of lumbar puncture procedures.

What are the symptoms of a spinal headache?

Symptoms of a spinal headache typically develop within two to three days of a spinal tap. But they can also develop months afterward.

Symptoms of a spinal headache include:

• Intense dull or throbbing headache that starts in the front or back of your head.
• Headache pain that increases when you sit or stand and gets better when you lie down.
• Headache pain that worsens when you cough, sneeze or strain.
• Nausea.
• Neck pain or stiffness.
• Dizziness.
• Vision changes and sensitivity to light (photophobia).

Less common symptoms include:

• Tinnitus.
• Hearing loss.
• Radiculopathy symptoms in your arms, like tingling or numbness.

How long does a spinal headache last?

Spinal headaches typically last from a few hours to a few days, but can last longer. See your healthcare provider if your symptoms continue for more than 24 hours.

What causes a spinal headache?

The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. Healthcare providers perform spinal taps to diagnose certain conditions and to deliver anesthesia, like when pregnant people have an epidural during labor and delivery.

During a lumbar puncture, a provider inserts a needle into your spinal canal in your lower back to deliver anesthesia or withdraw a sample of cerebrospinal fluid. Sometimes, spinal fluid leaks out of this tiny hole.

The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache.

Other conditions can cause spinal fluid leaks that lead to spinal headaches, including:

• A ruptured (burst) cyst on your spinal cord.
• A tear in the meninges of your spinal cord.
• A head or face injury, such as a fractured skull.

What are the risk factors for a spinal headache?

Risk factors for spinal headaches include:

• Dehydration.
• Systemic illness (conditions that affect your whole body, like high blood pressure or the flu).
• History of headaches.
• Low body mass index (BMI).
• The use of a cutting or larger bore spinal needle.

Spinal headaches are most common in pregnant people aged 20 to 40 years old due to the use of epidurals during labor.

How is a spinal headache diagnosed?

A healthcare provider diagnoses a spinal headache based on your history and symptoms. If you’ve had a spinal tap in the last 14 days, the diagnosis is often obvious. In that case, you usually don’t need tests.

If you haven’t had a spinal tap, providers typically use magnetic resonance imaging (MRI) to diagnose the source of the headache. This imaging test allows your provider to see your brain and spinal cord to look for signs of leaking cerebrospinal fluid.

How is a spinal headache treated?

To manage most spinal headaches, healthcare providers recommend:

• Lying down in a flat position.
• Drinking lots of fluids, including drinks containing caffeine (like coffee, tea and some soft drinks).
• Taking over-the-counter pain relievers (analgesics).

Sometimes, these measures don’t relieve the pain. If a spinal headache lasts more than a few days, your provider may recommend an epidural blood patch. During this procedure, a provider injects a small amount of your blood over the hole that’s leaking CSF. When the blood clots, it seals the hole.

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

Can a spinal headache be prevented?

There’s generally nothing you can do to prevent a spinal headache. Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

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

The prognosis (outlook) for a spinal headache is generally good. About 85% of all spinal headaches get better without treatment. About 60% to 70% of people who have an epidural blood patch no longer have a spinal headache within 24 hours.

In rare cases, prolonged or severe spinal headaches can lead to the following complications:

• Cerebral venous sinus thrombosis.
• Subdural hematoma.
• Seizures.
• Hypopituitarism.
• Syringomyelia.
• Brain herniation (when increased pressure causes part of your brain to bulge).
• Coma.
• Death.

When should I see my healthcare provider?

Contact your healthcare provider if you experience a severe headache after a spinal tap, especially if it lasts longer than 24 hours. Get immediate medical attention if you experience difficulty peeing or lose feeling in your back or legs. These are signs of serious complications.

A note from Cleveland Clinic

Everyone gets headaches from time to time for various reasons. But spinal headaches aren’t ordinary headaches. If you experience a severe headache after getting a spinal tap or epidural, tell your healthcare provider. While most spinal headaches go away on their own, you might need an epidural blood patch to treat it.