Spinal Headaches: Symptoms, Causes, Treatment

What are the symptoms of spinal headaches?

The symptoms of a spinal headache, also known as a post-dural puncture headache, typically include:

• Intense headache: Often described as a dull, throbbing pain that is usually worse when sitting or standing and improves when lying down.
• Pain location: The headache is often felt at the back of the head or neck but can spread across the entire head.
• Neck stiffness: Tightness or discomfort in the neck may accompany the headache.
• Nausea and vomiting: Feeling sick to the stomach or vomiting can be common symptoms.
• Sensitivity to light (photophobia): Bright lights may exacerbate the headache.
• Hearing changes (tinnitus): Ringing in the ears or muffled hearing can occur.
• Dizziness: Lightheadedness or feeling faint, especially when changing positions.
• Blurred vision or double vision: Visual disturbances can accompany the headache.

Spinal headaches usually occur after procedures involving a lumbar puncture (spinal tap) or epidural anesthesia, where cerebrospinal fluid (CSF) leaks from the puncture site, leading to reduced pressure around the brain and spinal cord.

What are the causes of spinal headaches?

Spinal headaches, also known as post-dural puncture headaches, are primarily caused by a leak of cerebrospinal fluid (CSF) from the puncture site in the dura mater (the outermost membrane surrounding the brain and spinal cord). When the CSF leaks, it lowers the pressure within the skull, leading to a headache. Key causes of spinal headaches include:

• Lumbar puncture (spinal tap): This procedure, performed to collect CSF for diagnostic testing, involves puncturing the dura with a needle, which can lead to CSF leakage.
• Epidural anesthesia: Administered during labor or certain surgeries, epidurals can unintentionally puncture the dura, causing a spinal headache.
• Myelography: A procedure involving the injection of contrast dye into the spinal canal, which can occasionally cause a dural puncture and subsequent headache.
• Trauma: In rare cases, trauma or injury to the spine can result in a dural tear and lead to a spinal headache.
• Spontaneous CSF leak: Some individuals may develop a spontaneous CSF leak without any apparent cause, leading to a similar type of headache.

These headaches typically worsen when standing or sitting and improve when lying down due to changes in CSF pressure.

How is the diagnosis of a spinal headache made?

The diagnosis of a spinal headache, also known as a post-dural puncture headache, is typically made based on a combination of medical history, clinical symptoms, and a recent history of a procedure that involved puncturing the dura mater (such as a lumbar puncture, epidural anesthesia, or spinal surgery). Key steps in the diagnostic process include:

• Patient History: The healthcare provider will ask about recent procedures, such as a lumbar puncture or epidural, that could have caused a cerebrospinal fluid (CSF) leak. The timing of the headache in relation to the procedure is a critical factor.
• Characteristic Symptoms: The hallmark symptom of a spinal headache is a severe headache that worsens when the patient is sitting or standing and improves when lying down. The headache is often accompanied by neck stiffness, nausea, dizziness, sensitivity to light (photophobia), and, in some cases, hearing changes.
• Physical Examination: The provider may perform a neurological exam to check for any other signs or symptoms that could be related to a spinal headache or other neurological conditions.
• Imaging Tests (if needed): In most cases, imaging is not required to diagnose a spinal headache. However, in complex or uncertain cases, an MRI or CT scan may be performed to rule out other causes of the headache or to confirm the presence of a CSF leak.

The diagnosis is primarily clinical, based on the context of recent procedures and the characteristic symptoms.

What is the treatment for spinal headaches?

Treatment for spinal headaches, also known as post-dural puncture headaches, varies based on the severity of the symptoms. Common treatment approaches include:

• Bed Rest: Lying down can help alleviate symptoms because spinal headaches typically worsen when sitting or standing due to the reduced pressure in the cerebrospinal fluid (CSF) space.
• Hydration: Increasing fluid intake, especially with caffeine-containing beverages, can help alleviate the headache. Caffeine constricts blood vessels and may help reduce symptoms.
• Pain Relief: Over-the-counter pain relievers like acetaminophen or ibuprofen can be used to manage pain. In more severe cases, prescription medications might be necessary.
• Caffeine: Caffeine can be administered orally or intravenously as it helps to constrict the blood vessels and can reduce the severity of the headache.
• Epidural Blood Patch: This is the most effective treatment for severe spinal headaches. It involves injecting a small amount of the patient’s own blood into the epidural space at the site of the dural puncture. The blood forms a clot that seals the leak in the dura, thereby restoring normal pressure in the CSF space and relieving the headache.
• Fluids and Electrolytes: Intravenous fluids may be administered to help maintain hydration and electrolyte balance, which can support the body in recovering from the headache.
• Alternative Therapies: Some patients find relief with alternative therapies like acupuncture or massage, though these are typically considered adjunctive treatments.
• Time: In some cases, spinal headaches resolve on their own without any specific treatment within a few days to a week.

If symptoms persist or are particularly severe, seeking medical attention is important, as a spinal headache can sometimes indicate a more serious underlying issue that needs to be addressed.