Patient education: Spinal headache (The Basics)

What is a lumbar puncture? — A lumbar puncture, or "LP," is a procedure doctors use to access the fluid around your spinal cord. It is also called a "spinal tap."

The spinal cord is a bundle of nerves that runs from the base of your brain down your back, inside the bones of your spine. It is surrounded by fluid called "cerebrospinal fluid" or "CSF." The spinal cord and CSF have a covering called the "dura." To do an LP, your doctor will insert a needle into your lower back, between two of the bones. The needle passes through the dura so the tip is in the CSF (figure 1).

Doctors might do an LP for different reasons, including:

●To check for problems that affect the brain or spinal cord – During an LP, doctors measure the pressure of the CSF. They can also take a sample of it for testing. This can help them look for things like infection, bleeding in the brain, nerve problems, or other medical conditions.

●To give medicine directly into the area surrounding the spinal cord – This is a common way to give anesthesia (medicines to make sure you don't feel pain during surgery or a procedure). This type of anesthesia is called "spinal" anesthesia. It is used to block pain in your lower body, for example, during childbirth or surgery. An LP can also be used to give other types of medicine, such as chemotherapy medicines (during cancer treatment) or antibiotics.

●To do a procedure called a "myelogram" – This is a special kind of X-ray that involves injecting dye into the CSF. It is sometimes done to check for problems with the spine, nerves, or spinal cord.

What is a spinal headache? — A spinal headache is a headache that can sometimes happen within a few days after a person has an LP. This happens because the spot where the needle goes in does not always close up right away. If the hole stays open, CSF can leak out. This lowers the pressure inside the skull, causing a headache.

Doctors also use the terms "post dural puncture headache" or "post lumbar puncture headache."

Who is at risk for a spinal headache? — It's not possible to know exactly who will get a spinal headache after having an LP. But there are some things that might make it more likely. Your risk might be higher if you:

●Are female

●Are pregnant

●Have had headaches often in the past

●Are younger than 50

The needle your doctor uses to do the LP might also affect your risk. Larger needles, and those with a certain shape tip, might increase the risk that you will get a spinal headache.

Will I get a headache after an epidural? — "Epidural" anesthesia is often used to block pain during childbirth. It can be used for other procedures, too. For an epidural, a doctor puts a needle into your lower back, like for an LP. But instead of making a hole in the dura, the doctor inserts a thin tube called a "catheter" in the space around it. The catheter is left in place to deliver medicine to the area.

An epidural should not lead to a headache since it does not involve making a hole in the dura. But if the needle goes in too far, it can accidentally make a hole. This doesn't happen very often, but if it does, it can cause a spinal headache.

What are the symptoms of a spinal headache? — The main symptom is a headache, usually in the front or back of the head. The headache gets worse if you sit or stand up, and better when you lie down.

Many people get other symptoms, too. They include:

●Nausea

●A stiff neck

●Low back pain

●Dizziness

●Vision problems, such as double vision, blurry vision, or sensitivity to light

●Hearing problems, such as ringing in the ears or temporary hearing loss

Will I need tests? — It depends. Your doctor or nurse should be able to tell if you have a spinal headache by learning about your symptoms and doing an exam.

Depending on your symptoms, you might get tests to make sure something else is not causing your headache. These can include imaging tests such as a CT scan or MRI. Imaging tests create pictures of the brain.

How is a spinal headache treated? — In most cases, a spinal headache goes away on its own, usually within a week. Until then, lying down will help your headache. You can also take pain medicines like acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). Some people find that caffeine helps, especially if they are used to drinking caffeinated beverages like coffee every day.

If your headache does not improve after a day or so, your doctor might suggest a treatment called a "blood patch." This involves taking a small amount of your blood and injecting it into the area where the LP was done.

Can spinal headache be prevented? — No. There is no way to completely prevent a spinal headache after having an LP. But your doctor might be able to lower the risk by doing the LP with a smaller needle with a certain kind of tip.

More on this topic

Patient education: Lumbar puncture (spinal tap) (The Basics)
Patient education: Headaches in adults (The Basics)
Patient education: Anesthesia (The Basics)

Patient education: Headache causes and diagnosis in adults (Beyond the Basics)