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Headache as a Side Effect of Lumbar Punctures

Spinal Taps Can Lead to Painful Headaches in Many People

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Updated August 05, 2009

Headaches are the most common side effect of lumbar punctures (also called spinal taps). Estimates on how common they are range from 15% to as high as 50% of people getting a lumbar puncture. Since I have not had a lumbar puncture myself, I can’t share any direct experience. However, I have seen these headaches described by different people as: excruciating, frightening, and “no big deal.” Although they are an unfortunate and often painful side effect of a common procedure, which in itself can be stress-inducing, they can be effectively treated by different methods.

What Does a Post-Lumbar Puncture Headache Feel Like?

  • The headache occurs within three days of the procedure.
  • These headaches either cause pain in the front of the head (usually directly behind the eyes) or in the back of the head, near the base of the skull.
  • They are much worse when sitting or standing, and are relieved when the person lies down.
  • They can be accompanied by ringing in the ears, nausea, dizziness and vision problems.
  • What Causes These Headaches?

    Nobody knows for certain what causes post-lumbar puncture headaches. When a lumbar puncture is performed, the technician must puncture the dura, the membrane that contains the brain and spinal cord, as well as the cerebrospinal fluid that they are suspended in. One theory is that if there is continued leakage of cerebrospinal fluid, it cannot be replenished fast enough. This causes the brain to “sag” in place and stretches pain-sensitive structures. Another possible cause could be dilation (widening) of the veins in the brain after the procedure.

    How Severe Can a Post-Lumbar Puncture Headache Be?

    While the majority of these headaches are not pretty severe, most will respond quickly to painkillers. However, some people find them so painful that they are immobilized with pain. In very rare cases, if they go untreated, post-lumbar puncture headaches can be a sign that something more serious needs to be addressed. Serious complications include subdural hematoma and seizures, which could be fatal.

    Who Is Most Likely to Get a Post-Lumbar Puncture Headache?

    Anyone can suffer from a headache following a lumbar puncture. However, it seems to be most likely if you are: female, between the ages of 20 and 40, and have a history of headaches.

    How Are They Prevented?

    Needle Choice: A couple of studies have shown that using smaller needles (rather than larger-bore needles) or “atraumatic” needles (rather than conventional “cutting” needles) results in a much lower incidence of post-lumbar puncture headache. The only potential drawback of the smaller needles or atraumatic needles is that they may require greater expertise to insert, meaning that there may have to be more attempts to successfully get a sample.

    Bedrest Debunked: For a long time, it has been recommended that people stay in bed for a period of time following a lumbar puncture, lying flat on their backs. A review of several studies has shown that this really doesn’t seem to have an effect at all and that patients that got up right away are no more likely to have a headache that those who stay in bed.

    How Are They Treated?

    First, Try Conservative Measures: Most headaches that follow lumbar punctures are mild and tend to resolve on their own. They also tend to respond well to painkillers, including opioids, if necessary. This should take care of most of the pain while waiting for the headache to go away on its own.

    Epidural Blood Patch: This is probably the next thing that will be tried if the headache pain lasts more than 24 hours and is so severe that painkillers do not provide relief. It is shown to be successful in up to 98 percent of patients, although it occasionally needs to be done twice. The procedure is simple: Blood is taken out of a vein and injected into your epidural space (the space outside the dura). A small amount of local anesthesia will be used and you will be asked to rest for about 30 minutes, then stand up. This procedure works by “plugging the leak” in your dura.

    Intravenous Caffeine: This is thought to work by causing the vascular system in the brain to constrict. This method seems to have very few side effects and works in some cases. However, there are no well-designed studies of this method.

    Epidural Saline: Another method of treating these headaches is to inject saline into the epidural space, which is thought to compress the dura enough to allow the hole made by the needle to heal. However, the saline leaves the epidural space quickly, so even though most patients report immediate relief from this method, the headache returns about half the time.

    Additional Information/Points

    Avoid Aspirin: Aspirin should not be used to treat post-lumbar puncture headaches, as its anti-clotting properties would slow healing of the hole in the dura.

    Sources:

    Sun, C, Lay, CL. Post-lumbar puncture headache. UpToDate. Accessed: December 2008.

    Silberstein, SD, Marcelis, J. Headache associated with changes in intracranial pressure. Headache 1992; 32:84.

    Morgenlander, JC. Lumbar puncture and CSF examination. Answers to three commonly asked questions. Postgrad Med. 1994; 95:125.

    Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI, Crum BA, Dodick DW. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist. 2007 Sep;13(5):323-7.

    Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006 Nov;82(973):713-6.

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