Have you ever had an unbearable headache, especially after an injection in your back? Or do you feel that the pain gets worse when you sit or stand, and gets better when you lie down? If so, you may have a condition called Spinal Headache, which we are going to talk about today. Don't worry, let's talk about it in detail .
What is a Spinal Headache?
Simply put, a spinal headache is a severe headache caused by a decrease in the amount of cerebrospinal fluid (CSF) , the fluid that surrounds your brain. Imagine that our brain and the spinal cord, which run down your spine, are protected like a pillow filled with this watery fluid called CSF. This fluid nourishes the brain and protects the brain and spinal cord from sudden movements.
So, if for some reason this CSF fluid around the brain decreases, that is, if it leaks, the support for the brain decreases. Then the brain starts to sag a little. At this point, the delicate tissues and nerves that are connected to the brain start to pull. That pulling is what we feel as a severe headache.
This is also called:
- Post-dural puncture headache
- Epidural headache
- Low-pressure headache
Why does this spinal headache occur?
The main reason for this is a medical procedure we call "spinal tap." That is, a lumbar puncture or spinal tap .
Spinal Tap/Lumbar Puncture is the main cause
Doctors do lumbar punctures for a number of reasons. To get a CSF sample to diagnose certain conditions, or to administer anesthesia. You may remember the epidural anesthesia given to the spine to reduce pain during childbirth. That's what it's done for.
In this procedure, a doctor inserts a thin needle into your spinal canal, either through your lower back or to administer anesthesia or to take a sample of CSF. However, sometimes a small hole in the meninges, the membrane that surrounds the spinal cord, can cause some CSF to leak out.
When the CSF fluid decreases, the pressure around the brain also decreases. We call this intracranial hypotension . Then the brain seems to hang down a little. That's what causes the headache.
Studies suggest that this type of spinal headache can occur in about 10% to 40% of lumbar punctures.
Are there other reasons?
Yes, it's not just a spinal tap. Rarely, CSF leakage can also cause spinal headaches due to other causes.
- A cyst that looks like a water blister near your spinal cord bursts.
- A tear in the protective membranes (meninges) surrounding the spinal cord.
- A serious injury to the head or face, such as a fractured skull.
What are the symptoms of a spinal headache?
For someone who has had a spinal tap, these headaches usually start within two to three days. However, they can sometimes appear months later.
The main features are these:
- A severe, throbbing headache that starts in the forehead or back of the head.
- The pain increases when you sit or stand, and decreases slightly when you lie down. This is the main, most distinctive feature of this headache.
- The headache gets worse when you cough, strain, or try to defecate.
- Nausea.
- Neck pain or stiffness.
- Dizziness.
- Vision changes and sensitivity to light, i.e. photophobia .
In addition, the following symptoms may also be seen rarely:
- Hearing a ringing in the ears (Tinnitus) .
- Hearing loss.
- Symptoms such as numbness or loss of sensation in the hands (Radiculopathy symptoms) .
How long can these symptoms last?
Most of the time, these spinal headaches can last from a few hours to a few days. But for some people, they can last longer. If you have these symptoms for more than 24 hours, you should definitely see a doctor.
Who is more likely to develop these? (Risk Factors)
Some people are more likely to develop these spinal headaches. There are several factors that contribute to this:
- Drinking less water (dehydration).
- Conditions that affect the whole body, such as high blood pressure and fever.
- Being someone who gets headaches frequently.
- For those with low body weight (Low body mass index - BMI).
- The type of needle used for the spinal tap. This risk is higher when certain types of needles (cutting or larger bore spinal needles) are used.
Most often, these spinal headaches are seen among women between the ages of 20 and 40 who receive epidural anesthesia for their back while giving birth.
How does a doctor know for sure that this is a spinal headache?
A doctor will determine whether it is a spinal headache based on the questions you ask (your medical history) and your symptoms. If you have had a spinal tap recently, that is, within 14 days, the diagnosis is very clear. In that case, no further tests are needed.
However, if you don't have a spinal tap, your doctor may order an MRI (Magnetic Resonance Imaging) scan to find the cause of your headache. This can take a closer look at your brain and spinal cord to see if there is any leakage of CSF fluid.
What are the treatments for this?
Doctors often recommend the following to treat a spinal headache:
Things you can do at home
- Lie down on a flat surface and lie down. It is best to lie down as much as possible, as standing and sitting can cause more pain.
- Drink plenty of water and fluids. Especially beverages containing caffeine, such as coffee, tea, and some soft drinks, can provide relief.
- Use over-the-counter pain relievers/analgesics that you can get from the pharmacy.
Treatment by a doctor
Sometimes the above treatments don't help. If you still have a headache after a few days, your doctor may recommend a procedure called an epidural blood patch . This involves injecting some of your own blood into the hole where the CSF is leaking. The blood clots and seals the hole. This helps many people recover quickly.
Very rarely, surgery is required to repair a CSF leak.
Can a spinal headache be prevented?
There's really nothing you can do to prevent this. However, doctors use a special type of needle (non-cutting needle) that is as thin as possible when performing a spinal tap to reduce this risk.
How quickly will this heal? (Prognosis)
There is nothing to be afraid of about these spinal headaches. Most of the time (about 85%) they will go away without any treatment. If we use the epidural blood patch treatment we talked about earlier, the headache will be completely gone within 24 hours in 60% to 70% of cases.
However, rarely, serious conditions can occur...
Although this is very rare, persistent, severe spinal headaches can lead to complications such as:
- Cerebral venous sinus thrombosis – A blood clot in the blood vessels of the brain.
- Subdural hematoma – a collection of blood around the brain.
- Seizures.
- Hypopituitarism – decreased function of the pituitary gland.
- Syringomyelia – The formation of fluid-filled cavities within the spinal cord.
- Brain herniation – a protrusion of part of the brain due to excessive pressure.
- Coma state.
- Even death can occur (but this is very rare ).
We don't say this to scare you, but it's good to be aware of this kind of situation. That's why we say that if your headache is severe and persistent, you should definitely see a doctor.
When should I see a doctor?
If you have a severe headache after a spinal tap and it lasts more than 24 hours, you should definitely see a doctor.
Also, if you have difficulty urinating, or if you feel like you're losing sensation in your back or legs, it could be a sign of a serious complication. If this happens, you should go to the hospital immediately.
Take-Home Message
We all get headaches from time to time for various reasons. But a spinal headache is not your average headache. If you have a severe headache after a spinal tap or an epidural, tell your doctor. Most of the time, these headaches will go away on their own, but you may need treatment, such as an epidural blood patch. Therefore, it is important to seek medical advice before making any decisions on your own.
` Spinal headache, spinal tap, headache, lumbar puncture, epidural, CSF, cerebrospinal fluid
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