Post-dural Puncture Headaches
By Alicia Henderson, M.D.; Richard C. Month, M.D., FASA; and Nathaniel Hsu, M.D.
Post-dural puncture headaches sometimes happen after an epidural or a spinal. What are they, why do they happen, and how do we fix them?
Headaches after having a baby are very common for many different reasons. A post-dural puncture headache is one type of headache that can occur after spinal or epidural anesthesia. It is caused by a leak of spinal fluid through a small hole made in the dura, the sac that surrounds the spinal cord.
About one out of every 150 women who get an epidural or spinal will have a post-dural puncture headache. Headaches are caused in two different ways:
- In some cases, we know there is a hole made in the dura. When this happens, you will be watched closely while you are in the hospital and for a short time after you go home.
- In some cases with epidurals, we do not know there is a hole in the dura. In these cases, the hole in the dura is probably caused by rubbing of the catheter or the epidural needle against the dura.
The headache usually starts within two days of an epidural or spinal. It almost always starts within five days. The headache is usually in the front or back of the head, is worse when sitting up or standing and better when lying down. The pain may move to the neck or shoulders as well. Other symptoms include nausea, vomiting, stiff neck, sensitivity to light, vision changes, and changes in hearing.
If you start to have a headache that sounds like this, you should tell your obstetrician or nurse as soon as possible. If you are still in the hospital, they may contact the anesthesia team to check on you. If you are at home, your obstetrician may have you come to the office, to the emergency room, or somewhere else, so that the anesthesia team can check on you.
- The hole in the dura usually closes by itself and the headache gets better in two weeks or less whether treated or not. Fluids, caffeine, ibuprofen, lying flat, and avoiding heavy lifting and straining may help. Also, an epidural blood patch can help severe headaches or headaches that are getting worse.
- An epidural blood patch is done by putting a small amount of your own blood into your back to help seal the hole in the dura. To do this, blood is cleanly taken from your arm and injected through an epidural needle placed in your back. An epidural blood patch may cause short-term back pain, and, like any epidural, there is a small risk of creating a new hole in the dura. Most post-dural puncture headaches get much better after one epidural blood patch, but sometimes they must be treated twice.
Most patients who have a post-dural puncture headache will not get another one after their next epidural or spinal. However, some rare conditions may make these headaches more likely to happen again. Tell your anesthesiologist if you have ever had one of these headaches so that you can discuss your options before delivery.