Overview

Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the membrane that surrounds the spinal cord and, in the lower spine, the lumbar and sacral nerve roots.

During a spinal tap, a sample of cerebrospinal fluid is withdrawn from the spinal canal. During spinal anesthesia, medication is injected into the spinal canal to numb the nerves in the lower half of the body. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache.

Most spinal headaches — also known as post-dural puncture headaches — resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment.

Symptoms

Spinal headache symptoms include:

  • Dull, throbbing pain that varies in intensity from mild to very severe
  • Pain that typically gets worse when you sit up or stand and decreases or goes away when you lie down

Spinal headaches are often accompanied by:

  • Dizziness
  • Ringing in the ears (tinnitus)
  • Hearing loss
  • Blurred or double vision
  • Sensitivity to light (photophobia)
  • Nausea and vomiting
  • Neck pain or stiffness
  • Seizures

When to see a doctor

Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up or stand.

Causes

Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) 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 48 to 72 hours after a spinal tap or spinal anesthesia.

Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured.

Risk factors

Risk factors for spinal headaches include:

  • Being between the ages of 18 and 30
  • Being female
  • Being pregnant
  • Having a history of frequent headaches
  • Undergoing procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord
  • Having a small body mass

May 10, 2022
  1. Walls RM, et al., eds. Headache disorders. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 27, 2022.
  2. Gropper MA, et al., eds. Spinal, epidural, and caudal anesthesia. In: Miller's Anesthesia. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Feb. 27, 2022.
  3. Bateman BT, et al. Post dural puncture headache. https://www.uptodate.com/contents/search. Accessed Feb. 27, 2022.
  4. Post-lumbar puncture and other low-pressure headaches. Merck Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/headache/post%E2%80%93lumbar-puncture-and-other-low%E2%80%93pressure-headaches?qt=&sc=&alt=. Accessed Feb. 27, 2022.
  5. Waldman SD. Post-dural puncture headache. In: Atlas of Uncommon Pain Syndromes. 4th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Feb. 27, 2022.

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