A spinal headache is common in individuals who have undergone procedures like lumbar puncture. It causes intense pain that may last for weeks and even longer in the worst scenarios. Medical students should thoroughly understand this condition to prepare for their syllabus. Read along for a detailed overview of spinal headache, its symptoms, causes, risks, and treatment.

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What is Spinal Headache?

Spinal headache occurs due to leakage of cerebrospinal fluid from the layers of tissue that cover your spinal cord and brain (meninges). The leakage is followed by an epidural anaesthesia or lumbar puncture (spinal tap). 

Due to this leakage, fluid pressure reduces around your spinal cord and brain, causing a post-dural headache (another name for spinal headache). This headache feels better when you lie down and gets worse when you are standing or sitting.

Spinal headaches are of two types:

• Acute Spinal Headache

It occurs after a spinal puncture, like an epidural or lumbar puncture. It does not stay for long and can be cured.

• Chronic Spinal Headache

This type of spinal headache persists for an extended period. It occurs mainly due to the leakage of cerebrospinal fluid.

What are the Symptoms of Spinal Headaches?

You can experience the symptoms of spinal headache after two to three days of getting a spinal tap. In some cases, the symptoms may develop after several months. Spinal headache causes the following symptoms:

• Headache gets worse with sneezing, coughing, or straining
• Throbbing or intense dull headache occurring in the back or front of your head
• Headache that feels better when you lie down but increases as soon as you stand or sit
• Pain in the neck area or stiffness
• Photophobia (changes in vision and light sensitiveness)
• Nausea 
• Dizziness

Apart from these, you may also experience some of the less common symptoms like the following:

• Loss of hearing
• Tinnitus
• Symptoms of radiculopathy in your arms which lead to numbness or tingling

What are the Risk Factors Associated with Spinal Headaches?

The following are the risk factors that can lead to a spinal headache:

• Pregnancy
• If you are between the age group 18 and 30 years
• If you are a female
• Individuals who experience frequent headaches
• If you have been under specific procedures that have made multiple punctures with larger needles around the membrane of your spinal cord
• Dehydration
• If you have a low BMI (body mass index)
• Any systematic illness like flu or high blood pressure that affects one’s whole body
• Females between 20 and 40 years of age who have received epidurals during their labour

What Causes Spinal Headaches?

Following is an overview of how spinal headaches occur:

• A spinal headache occurs when cerebrospinal fluid (CSF) leaks through a puncture in the dura mater, the membrane surrounding the spinal cord. 
• This often happens after procedures like a lumbar puncture or epidural anaesthesia. 
• In this procedure, a needle is inserted in a female’s spinal canal, which may lead to leakage of fluid sometimes.
• The CSF leak reduces fluid pressure around the brain, causing it to sag and stretch surrounding tissues and nerves, leading to intense headaches. 
• Symptoms typically worsen when standing and improve when lying down. 

While most spinal headaches resolve naturally, severe cases may require treatment, like an epidural blood patch to seal the leak. 

Here are some conditions that may cause spinal headaches due to the leakage of spinal fluid:

• Injury in the face or head
• If there is a tear in the spinal cord meninges
• When a cyst on the spinal cord bursts

How to Diagnose Spinal Headache?

A spinal headache is often diagnosed based on a patient’s medical history and symptoms. In this regard: 

• If the patient has undergone a spinal tap (lumbar puncture) or spinal anaesthesia within the past 14 days, the diagnosis is usually straightforward and does not require additional tests.
• Healthcare providers rely on the temporal association between the procedure and the onset of symptoms, such as headaches that worsen when standing and improve when lying down. 

If no recent spinal procedures have been performed, providers typically ask for the following tests:

• Magnetic Resonance Imaging (MRI)

MRI scans use magnetic fields and radio waves to create detailed brain and spinal cord images, allowing providers to identify cerebrospinal fluid leaks or other abnormalities causing the headache. This imaging helps rule out other potential causes of headaches, such as infections or structural issues.

• Myelography

In rare cases, additional diagnostic procedures like myelography may be used. This involves injecting contrast dye into the spinal canal to visualise CSF flow using fluoroscopy or CT scans. These advanced techniques are typically reserved for complex cases where standard imaging fails to pinpoint the issue.

By combining patient history with imaging results, healthcare providers can accurately diagnose spinal headaches and recommend appropriate treatments.

What are the Treatment Procedures for Spinal Headaches?

Acute spinal headaches can be cured on their own within a few days or weeks. However, for chronic conditions, you may need to undergo the following treatments:

• Bed Rest

A 24–48-hour bed rest can help ease the spinal headache. Since the condition worsens when you stand or sit down, lying down is the best option to relieve such pain.

• Hydration

Staying hydrated can increase the CSF pressure, reducing the pain. Doctors might also provide you with intravenous fluids if need be.

• Medication

Doctors may suggest medicines like theophylline, gabapentin, or hydrocortisone if your spinal headache is not cured with other methods.

• Caffeine

Drinking beverages that contain caffeine can also help reduce spinal headaches.

• Blood Patch

An epidural blood patch treats spinal headaches by injecting a small amount of the patient’s blood into the epidural space to seal cerebrospinal fluid leaks. This restores pressure, alleviating headaches effectively and often providing immediate relief.

How is a Spinal Headache Different from a Regular Headache?

When a headache originates in your cranial area, it is a regular condition and has nothing to do with your spine. The cause of your headache creates the difference between a spinal headache and a regular headache.

Spinal headache is a normal side effect in the case of 40% of patients who have received spinal anaesthesia or spinal tap. However, if the situation gets worse, then medical intervention is necessary.

How Can You Prevent Spinal Headache?

Spinal headaches can be prevented by following some careful techniques while conducting any spinal procedure, like epidural anaesthesia. Here are some of them:

• The patient must be hydrated properly before the spinal procedure as well as afterwards.
• Doctors should follow the proper needle technique, which involves the usage of smaller gauge needles to lower the risks of leakage in CSF.
• If you remain in the lying position for some time after undergoing a spinal procedure, you may not experience a spinal headache.

FAQs About Spinal Headache

1. What is the duration of a spinal headache?

Spinal headaches may last for a few days or a week and then resolve on their own. However, the severity of the condition may vary from one person to another. In the worst cases, it can persist for long periods.

2. What complications may one face due to a spinal headache?

If untreated, spinal headaches can cause persistent pain, difficulty with daily activities, dehydration, fatigue, and rare complications like meningitis or subdural hematoma. Chronic headaches may develop if cerebrospinal fluid leaks persist.

3. What does a doctor ask while diagnosing spinal headaches?

A healthcare provider may ask about the headache’s onset, whether it worsens with specific positions (sitting, standing, lying down), and any history of headaches to assess potential spinal fluid leaks.

4. Is the prognosis for spinal headache positive?

The prognosis for spinal headaches is positive, with 85% resolving without treatment. For persistent cases, 60-70% experience relief within 24 hours after an epidural blood patch procedure.

5. When is the right time to visit a doctor for your spinal headache?

Contact your healthcare provider if a severe headache lasts more than 24 hours after a spinal tap. You must also seek immediate care if symptoms like difficulty urinating or numbness in the back or legs occur.

Conclusion

Understanding spinal headache is crucial for both patients and medical professionals. For healthcare providers preparing for exams like NEET PG or practising clinicians looking to deepen their knowledge, DocTutorials offer comprehensive resources. 

With expert-led video lectures, case-based discussions, and mock tests tailored to postgraduate medical education, we ensure you have the proper knowledge to manage spinal headaches effectively. 

Empower your learning journey with DocTutorials today!