Spinal Headaches: What Are the Symptoms and Is There a Gold Standard of Treatment?

If you've recently undergone a lumbar puncture (spinal tap) or received an epidural, a throbbing, insistent pain might be plaguing your head. You're not alone – this could be a spinal headache, a unique discomfort with its own set of triggers and remedies. We receive consultation requests on many occasions to diagnose and treat spinal headaches. There are a few common signs and symptoms to be aware of when distinguishing between a spinal headache and one that is not spinal in origin. Don’t let severe head pain ruin your quality of life. Continue reading to learn how you can get relief from a spinal headache.

What Exactly Is a Spinal Headache?

Spinal headaches, also known as postdural puncture headaches, are intense headaches caused by a leak of cerebrospinal fluid (CSF), the protective liquid surrounding your brain and spinal cord. This leak can occur through a tiny puncture in the dura mater, the membrane enclosing the CSF, during procedures like a spinal tap or epidural, causing the pressure around your brain to drop. Spinal headaches are a complication of needle insertion into the subarachnoid space through the dural sac and are more common after a diagnostic lumbar puncture (spinal tap) than spinal anesthesia and spinal interventional pain injections.

Spinal Headache Symptoms

A spinal headache is usually debilitating and interferes with normal function and daily activity. Individuals may complain of associated symptoms such as:

• Throbbing pain: The most common symptom, often located in the front or back of the head, radiating to the neck and shoulders.
• Positional worsening: The pain typically intensifies when standing, sitting, or performing activities that elevate your head. Lying down flat often provides relief.
• Neck and back stiffness: Along with the head pain, stiffness in the neck and back can add to the discomfort.
• Nausea and vomiting: In some cases, the headache can be accompanied by nausea, vomiting, and even dizziness.

How Long Does a Spinal Headache Last?

These symptoms manifest within 3 days in 90 percent of cases after needle insertion into the spine. Symptoms 5 days post-procedure and immediately post-procedure are rare. Patients often complain of severe headaches when sitting up or standing. Spinal headaches will virtually disappear while lying down. This is the hallmark sign of a spinal headache. Up to 85 percent of spinal headaches will resolve within 6 weeks.

Seek Expert Help for a Spinal Headache If:

• Your headache persists for more than 3 days.
• The pain is severe or progressively worsens.
• You experience nausea, vomiting, or fever.
• The headache interferes with your daily activities.

How Are Spinal Headaches Treated?

The goal of treatment is to restore pressure and replenish cerebrospinal fluid. Treatment options can be divided into both conservative and minimally invasive. Several key points about spinal headache treatment are as follows:

• The gold standard of treatment for persistent spinal headaches is an epidural blood patch (EBP). This minimally invasive procedure involves injecting a small amount of your own blood into the epidural space around your spinal cord, sealing the CSF leak, and relieving the pressure headache. An epidural blood patch is a safe and effective procedure used to treat spinal headaches and has been employed since the 1960’s; it is still considered the standard of care for postdural puncture headaches.
• Supportive care involves rehydration and analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs, antidepressants, antiepileptics, local anesthetics, and opioids).
• Bed rest is not an effective form of treatment.
• Caffeine can also help reduce headache severity.

Don't Suffer in Silence: Seek Help From a Pain Management Specialist

Spinal headaches, though unpleasant, are often manageable with proper care. Remember, early diagnosis and intervention are key to finding relief. If you experience any of the aforementioned symptoms following a spinal tap or epidural, and conservative measures prove inadequate, reach out to your primary care provider or a pain management specialist. With the right guidance and treatment, you can put that piercing pain behind you and get back to your life – headache-free.