Many people have an epidural or spinal injection for surgery or childbirth. A certain type of headache can occasionally develop after an epidural or spinal injection. This is called a post-dural puncture headache.
An epidural injection is given into the space that surrounds your spinal cord (called the epidural space). A spinal injection is given directly into the fluid that surrounds your spinal cord (called the cerebrospinal fluid). The injection can be a local anaesthetic or a medicine to relieve pain.
What causes it?
Your brain and spinal cord are surrounded by fluid. The fluid is called the cerebrospinal fluid (CSF). An epidural or spinal injection may cause a small leakage of fluid.
This leakage of fluid is not dangerous. But if too much fluid leaks out through the hole in the dura, the pressure of the rest of the fluid around the brain is reduced. This causes a typical headache, which is called a post-dural puncture headache. If you sit up, the pressure around your brain is reduced even more. This lowered pressure makes the headache worse.
Although the hole in the dura will usually seal over in a number of weeks, it is not usually a good idea to wait for this to happen. The brain is cushioned by the CSF around it. If the headache is left untreated, this cushioning is not present and bleeding into or around the brain may occasionally occur (this is called a subdural haematoma). A fit (seizure) can also happen but this is rare.
Read more about the causes of a headache after an epidural or spinal injection.
How often does this happen?
This type of headache is very uncommon. Somewhere between 1 in 100 and 1 in 500 people having an epidural or spinal injection will develop a post-dural puncture headache.
Young patients and women having the spinal or epidural for childbirth are more likely than other people to have a post-dural puncture headache.
What kind of headache is it?
A post-dural puncture headache is an unusual and specific kind of severe headache. It can often be felt at the front or the back of the head. It is worse when sitting or standing and it gets better when lying down flat. There may also be neck pain, sickness and a dislike of bright lights.
Some patients describe it as like a very bad migraine. It is most likely to start between one day and one week after you have the spinal or epidural injection.
Other causes of severe headache after childbirth
If you have a severe headache after having a baby, there are other causes of severe headache that your doctors need to consider. Some of these headaches are very serious and require immediate treatment.
What is the treatment?
Lying flat as much as you can will help to improve the headache. You should also drink plenty of fluid. Caffeine drinks such as tea, coffee or cola are often helpful. You should avoid any heavy lifting and straining.
Simple pain-relieving medicine, such as paracetamol, can help to ease the headache. You can take ibuprofen as well.
What if it doesn't go away?
A post-dural puncture headache is often treated with an epidural blood patch. This involves having some of your own blood injected into your back. The aim of doing this is that the blood seals the hole in the dura and therefore stops the leak of fluid.
The blood patch will cure the headache within 24 hours in about 2 out of 3 people with this type of headache. If the headache continues, or if the headache returns, you may need to have another blood patch.
Find out more about the treatment for headaches after a spinal or epidural injection.
Further reading and references
Headache after a spinal or epidural injection; Royal College of Anaesthetists, February 2017
Cook TM, Counsell D, Wildsmith JA; Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009 Feb102(2):179-90. doi: 10.1093/bja/aen360. Epub 2009 Jan 12.
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