Spinal Headaches: What Are the Symptoms and Is There a Gold Standard of Treatment?

We receive consultation requests on many occasions to diagnose and treat spinal headaches. There are a few common signs and symptoms to be aware of when distinguishing between a spinal headache and one that is not spinal in origin. Don’t let severe head pain ruin your quality of life. Continue reading to learn how you can get relief from a spinal headache.

In this article:

We’ll take a quick spin through the key questions that will help you understand the symptoms of a spinal headache and how it can be effectively treated.

What Exactly Is a Spinal Headache?

A spinal headache, also known as a postdural puncture headache, is a complication of needle insertion into the subarachnoid space through the dural sac. The dural sac encases the spinal cord and cerebrospinal fluid.

This is a pressurized system that extends from the intracranial cavity down to the sacrum. Fluctuation in pressure can result in headache. This commonly occurs after diagnostic lumbar puncture. It is a less common complication of spinal anesthesia and spinal interventional pain injections.

What Symptoms Should I Be Aware Of?

Spinal headache is usually debilitating and interferes with normal function and daily activity. Individuals may complain of associated symptoms such as:

• Nausea
• Vomiting
• Visual disturbance
• Dizziness

These symptoms manifest within 3 days in 90 percent of cases after needle insertion into the spine. Symptoms 5 days post procedure and immediately post procedure are rare. Patients often complain of severe headache when sitting up or standing. Headache will virtually disappear while lying down. This is the hallmark sign of a spinal headache.

How Can Spinal Headache Pain Be Treated?

The goal of treatment is to restore pressure and replenish cerebrospinal fluid. Treatment options can be divided into both conservative and minimally invasive. Several key points about spinal headache treatment are as follows:

• Up to 85 percent of headaches will resolve within 6 weeks.
• Supportive care involves rehydration and analgesics.
• Caffeine can also help reduce headache severity.
• Bed rest is not an effective form of treatment.
• The gold standard of treatment is an epidural blood patch.

What to expect if you’re treated with an epidural blood patch: This is a minimally invasive procedure in which a spinal needle is introduced into the epidural space and the patient’s own blood is injected into the spine. This helps occlude the spinal fluid leak, once clotted and helps equilibrate intracranial pressure.

Initial relief is felt due to the compression of the dural sac after introduction of blood. Use of autologous blood acts as natural “spackling”, helping to patch the leaking dura. An epidural blood patch is a safe and effective procedure used to treat spinal headaches and has been employed since the 1960’s; it is still considered the standard of care for post dural puncture headache.