What You Need to Know About Lumbar Puncture Headaches
Post-dural puncture headaches often develop within a few days of a lumbar puncture (spinal tap). They usually go away on their own within a week or two, but if they persist, a doctor might recommend an epidural blood patch.
A lumbar puncture headache is a common side effect you may develop after undergoing a lumbar puncture (spinal tap) procedure. Experts estimate that one-quarter of all people who have a spinal tap develop this type of headache.
While usually a temporary side effect, there are ways you can help manage and treat lumbar puncture headaches. Consider the following information if you’re scheduled for a spinal tap or develop a headache after your procedure.
Language matters
You’ll notice that “women” is used when sharing stats and other data points in this article.
Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.
Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.
Interestingly, Americans show more favor toward Medicare for All healthcare initiatives than they do toward these efforts when they are labeled as “single payer,” most likely due to the popularity of the Medicare program, STAT
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A lumbar puncture headache (aka post-dural puncture headache [PDPH]) develops after a lumbar puncture procedure.
The purpose of a lumbar puncture is to retrieve cerebrospinal fluid (CSF). A doctor may order this procedure to test for infections, autoimmune diseases, or other conditions. You may also need a lumbar puncture for certain medications, such as anesthetics (including an epidural) or chemotherapy.
Sometimes, fluid may leak from the puncture site, resulting in a headache after the procedure. This can happen if the hole at the needle insertion site doesn’t close up, resulting in fluid leaking from your spine.
Your brain usually floats in CSF. A leakage of CSF can cause the brain to “ sink ” when you’re upright. This puts pressure on the nerves in the outer layers of the brain, causing pain.
Experts estimate 60% to 80% of people develop an acute lumbar puncture headache after accidental dural puncture during epidural anesthetic procedures. People at higher risk of PDPH include :
- women ages 20 to 40 years
- pregnant people
- people with a history of PDPH
- people with a low body mass index (BMI)
Needle size and lumbar puncture headaches
The needle a healthcare professional uses to perform a spinal tap can also affect your risk of a lumbar puncture headache. Although it seems intuitive, research confirms that the smaller the needle tip, the lower your risk of headache.
The angle of the needle, when inserted, can also affect your risk of headache.
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Lumbar puncture headaches tend to cause dull achiness rather than sharp pain. You may also feel them on both the front and back of your head.
Spinal headaches vary in severity. Some people may experience mild discomfort, while others might have pain that interferes with their daily activities. Some cases may also be more persistent, with pain tending to worsen upon standing.
In addition to a headache, you may also experience:
- nausea
- vomiting
- dizziness
- sensitivity to light
- neck pain
- backache
- low blood pressure (hypotension)
- increased heart rate
Spinal tap-related headaches may appear within a few hours of a lumbar puncture and usually appear within 48 hours. According to the International Headache Society (IHS), a headache needs to start within 5 days of a lumbar puncture for doctors to classify it as PDPH.
Developing a lumbar puncture headache isn’t necessarily a cause for concern. But you may want to talk with a doctor if your headache is chronic, accompanies other symptoms, or doesn’t improve with rest.
While the exact timeline varies, lumbar puncture headaches typically last from a few hours to several days . The IHS notes that it should resolve on its own in 2 weeks. It may resolve sooner if a doctor performs treatment to seal the leak.
When to contact a doctor
Contact a doctor if you’re experiencing a headache for longer than 5 days following a spinal tap procedure.
Seek immediate medical attention if you experience a sudden, severe headache that may be accompanied by stiffness, vision changes, or confusion. These may be symptoms of another serious medical condition.
A lumbar puncture headache usually improves on its own without medical intervention.
But doctors may treat severe cases with an epidural blood patch. This procedure involves taking a small sample of your own blood and injecting it into your lower back. The purpose is to form a blood clot to close the hole and stop the spinal leakage.
Various studies estimate that a blood patch improved people’s conditions 61% to 98% of the time. According to a 2020 review, it’s typical for people to experience immediate pain relief after a blood patch.
Depending on your tolerance, a doctor may recommend caffeine. According to a 2016 research review , oral or intravenous (IV) caffeine may help stimulate CSF production, causing a reduction in symptoms. Caffeine also acts as a vasoconstrictor by decreasing dilated blood vessels in your brain that may contribute to headaches.
- severe backache
- chronic back stiffness
- loss of feeling in your back or legs
- difficulty urinating
Lumbar puncture headaches tend to be worse when standing up. A doctor will likely encourage you to lie down as much as possible until your headache improves. They may also recommend over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil).
As caffeine may have a positive effect, some healthcare organizations suggest that 1 to 2 cups of coffee per day may help.
Long-term complications of a spinal headache are rare. Still, it’s important to see a doctor if you continue to have a severe headache a few days after your spinal tap. They can assess your condition and rule out other underlying causes.
Other possible risks associated with a spinal tap include:
- bleeding
- infections
- swelling
- a chronic headache that may last for months
There’s no sure way to prevent lumbar puncture headaches.
Doctors typically recommend rest for 24 hours following a spinal tap procedure. They may also encourage you to drink plenty of fluids. These strategies aim to reduce the amount of CSF leakage or increase CSF volume.
But there’s no evidence to suggest that these strategies help to prevent lumbar puncture headaches. Still, doctors commonly recommend them because they’re simple and don’t have any serious side effects.
A lumbar puncture headache is a common side effect after undergoing a spinal tap procedure. It develops when the hole in your spine from the puncture doesn’t close all the way, allowing spinal fluids to leak out of the site.
Most lumbar puncture headaches resolve on their own within a few days as your puncture heals. During this time, it’s important to rest and use OTC pain relievers as a doctor recommends. Call a doctor if your symptoms don’t improve within a few days.
Last medically reviewed on April 7, 2023
How we reviewed this article:
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