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 Diseases and Conditions
Spinal headaches
From MayoClinic.com
Special to CNN.com Introduction Spinal headaches may occur after a procedure such as a spinal tap or spinal anesthesia. During a spinal tap (lumbar puncture), a sample of cerebrospinal fluid is withdrawn from your spinal canal. During spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body. Both procedures require a puncture in the tough sac (dura) that surrounds the spinal cord. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache. With treatment, spinal headaches — also known as post-dural puncture headaches — typically disappear within 48 hours. Left untreated, spinal headaches usually go away within seven days. Signs and symptoms Spinal headaches vary in intensity from mild to incapacitating. The pain often gets worse when you sit up, stand or cough. It may decrease or go away when you lie down. Spinal headaches are often accompanied by:
Causes Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache. Spinal headaches typically appear within five days after a spinal tap or spinal anesthesia. Both of these procedures require doctors to puncture the membrane that surrounds the spinal cord. Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthesia is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is inadvertently punctured. Risk factors Spinal headaches are most common in adults ages 18 to 30 and those who already have a headache at the time of a spinal tap or spinal anesthesia. Spinal headaches affect twice as many women as men. The risk of spinal headaches increases with larger needles and multiple punctures in the membrane that surrounds the spinal cord. When to seek medical advice Consult your doctor if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up, stand or cough. Screening and diagnosis The doctor will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures — particularly a spinal tap or spinal anesthesia. Sometimes the doctor will recommend a magnetic resonance imagining (MRI) exam to exclude other causes of the headache. During the exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain. Treatment Treatment for spinal headaches begins conservatively. Your doctor may recommend taking pain relievers, lying flat and drinking plenty of fluids to increase pressure in the spinal fluid. Because caffeine constricts blood vessels, caffeinated drinks may be especially helpful in boosting pressure in the spinal fluid. Sometimes fluids or caffeine are given directly into the veins (intravenously). If conservative treatment doesn't help, the doctor may recommend injecting a small amount of your blood into the space over the hole in the dura. This is known as an epidural blood patch. The injected blood forms a clot that seals the puncture hole, restoring normal pressure in the spinal fluid and relieving your headache. Prevention To prevent spinal headaches, your doctor will use the smallest needle possible for a spinal tap or spinal anesthesia. It may help to drink plenty of fluids after either procedure as well. Although bed rest is often recommended for spinal headaches, lying down after a spinal tap or spinal anesthesia hasn't been proven to help prevent spinal headaches. February 21, 2006 |
