17927 Spinal Headaches

Overview

A spinal headache is a headache that can happen after a spinal tap (lumbar puncture), an epidural, or spinal anaesthesia. It occurs when spinal fluid leaks through a small hole in the protective membrane around the spinal cord, causing the brain to sag slightly and stretching pain-sensitive tissues.

It is one of the more common side effects after a lumbar puncture or epidural. Roughly 1 in 10 to 1 in 20 people who have these procedures will develop a spinal headache.

It can affect anyone who has had a spinal procedure, including women who have an epidural during childbirth, people having a diagnostic spinal tap, and those who receive spinal anaesthesia for surgery. It is more typical in younger adults and women.

Symptoms

Common symptoms

• A dull or throbbing headache that worsens when sitting or standing
• Pain at the back of the head that may spread to the neck or shoulders
• Nausea
• Dizziness
• Blurred vision
• Ringing in the ears (tinnitus)
• Feeling of relief when lying flat

Causes

Main causes

• A leak of cerebrospinal fluid through a tear or hole in the dura mater (the tough outer layer of the spinal cord)
• Most often from a lumbar puncture, epidural, or spinal anaesthetic
• Rarely, from spinal surgery or an injury

Risk factors

• Being aged 20 to 40
• Being female
• Having a history of chronic headaches
• Having a procedure with a larger needle or multiple attempts
• Being pregnant (epidural for labour)

When to see a doctor

See a doctor urgently if:

• If your headache is not relieved by lying flat
• If you develop a high fever or a stiff neck
• If you have double vision or changes in your vision
• If you are unable to drink enough fluids or urinate normally

Book a routine appointment if:

• If you have a mild headache that lasts longer than three days
• If you have questions about how to care for yourself after a spinal procedure
• If you want to talk about safe options to manage pain

Diagnosis

A healthcare professional will ask about your recent procedures and examine you. The classic sign is a headache that appears or worsens when you sit up and improves within a few minutes of lying flat.

Tests that may be done

• No laboratory test is needed in typical cases.
• An MRI scan may be used if the headache is unusual, if there is concern about a persistent leak, or if other conditions need to be ruled out.

What to expect at your appointment

Your doctor will do a neurological examination, checking your reflexes, balance, and eye movements. They may ask you to change positions to see how your symptoms respond. This is quick and painless.

Treatment

Resting flat and drinking fluids is the first line of treatment. Most spinal headaches improve within 48 hours with conservative care. If symptoms do not resolve, a procedure called an epidural blood patch is often very effective.

Self-care at home

• Lie flat as much as possible, avoiding sudden movements
• Drink plenty of water or other non-alcoholic fluids
• Ask your doctor or pharmacist about a safe, over-the-counter painkiller
• Avoid heavy lifting or straining
• Rest in a quiet, dark room if light bothers you

Medical treatments

When simple measures are not enough, your doctor may recommend intravenous fluids, prescription anti-nausea or pain-relieving medications, or other medicines to reduce inflammation. You should only take medications that your doctor has recommended. If the headache continues, an epidural blood patch — where a small amount of your own blood is injected near the spinal leak — can quickly seal the leak and resolve the headache.

When is surgery considered?

Surgery is very rarely needed. It may be considered only if the leak continues despite a blood patch and is causing severe symptoms. This would be discussed with a specialist in spinal anaesthesia or neurosurgery.

Living with this condition

Plan to spend as much time as possible lying flat during the first days. Keep a flask of water, snacks, and your phone close by. Move slowly when you need to sit up, and ask for help with household tasks and childcare.

Lifestyle tips

• Take regular breaks in a reclined position
• Avoid staying upright for long periods
• Ask for help with housework or lifting
• Use a lumbar pillow if you need to sit
• Stay hydrated throughout the day

Diet and exercise

Eat small, bland meals if you feel sick. Drink plenty of water — around 8 glasses a day unless your doctor says otherwise. When the headache settles, gentle walking and light stretching can help you rebuild energy, but avoid heavy lifting or strenuous workouts for at least a week.

Mental health and emotional wellbeing

It's normal to feel frustrated or low when a headache keeps you confined to bed. Talk to someone you trust about how you are feeling. Try relaxation techniques or calming music. If your mood remains low for more than two weeks, speak to your GP or a counsellor.

Prevention

You can reduce the risk of a spinal headache by ensuring the procedure is performed by an experienced doctor or anaesthetist, using a small needle, and getting the puncture correct on the first attempt. After the procedure, staying well hydrated and lying flat for a while may help, though it does not always prevent a headache.

Vaccines

There is no vaccine for spinal headaches.

Screening programmes

There is no routine screening test for spinal headaches.

Complications

If left untreated

• Most spinal headaches resolve without any long-term problems.
• If a leak persists for weeks, it can cause chronic headaches, neck pain, and hearing changes.
• In rare cases, very low pressure in the skull can lead to bleeding or infection in the spine, so it's important to keep your healthcare team informed.

Long-term outlook

With the right care, nearly everyone recovers completely. Most people feel better after a few days of rest, and a blood patch relieves the headache quickly in the rare cases that need it. The long-term outlook is excellent, and serious complications are very rare.

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