Patient information leaflets
Many people have epidurals or spinals for surgery. Some people may get a special type of headache after this. This leaflet explains the causes, symptoms and treatment of the headache. Your anaesthetist will be happy to talk with you in more detail. He or she will be able to answer any questions that you have.
What is special about the headache?
Headaches after surgery or child birth are common. However, after an epidural you have a 1 in 100 to 1 in 500 chance of a 'post dural puncture' headache.
This usually happens between one day and one week after having an epidural. It is usually a severe headache, felt at the front or back of your head. It gets better when you lie down and gets worse when you sit or stand. You may also have neck pain, sickness and a dislike of bright lights.
If you have a spinal anaesthetic, the headache tends to be less severe. It depends on the size of the needle used.
Young patients and women during child birth are especially likely to get it.
What causes it?
Your brain and spinal cord are contained in a bag of fluid. The bag is called the dura. The fluid is called the cerebrospinal fluid (CSF).
When an epidural is given, a needle is used to inject local anaesthetic just outside the dura. When this is done, the needle may pass through the dura. The chances of this happening depend on the experience of the anaesthetist and certain patient circumstances. You can talk with your anaesthetist about this.
When a spinal is given, a fine needle is put into the dura to inject local anaesthetic into the CSF. Too much fluid may leak out through the hole in the dura. The pressure in the rest of the fluid is then reduced. If you sit up, the pressure around your brain is reduced even more. This reduced pressure can cause a post dural puncture headache.
Some patients describe it as like a very bad migraine, made worse when they sit or stand up.
What can be done about it?
The hole in the dura usually mends itself in a number of weeks, but it can take longer.
Lying flat and taking painkillers such as paracetemol or ibuprofen, may help. You should drink plenty of fluid.
Some people find tea, coffee or cola especially helpful. Avoid lifting and straining.
If the headache is severe it will often need to be treated by an 'epidural blood patch'. This is like having an epidural, and takes about half an hour. The anaesthetist will take your blood and inject it near the hole in the dura. It will clot and form the blood patch, which will plug the hole.
This will usually cure the headache within 24 hours. If it does not, it may be worth having another blood patch. It is very rare to need more than two. Your anaesthetist will talk about this with you.
After having this done, you should lie flat in bed for four hours. Do not lift anything heavy for at least two days.
Are there any problems with a blood patch?
There is a chance of another dural puncture.
A blood patch may not cure your headache. In about 60 to 70% of patients, it will take away the headache very quickly. For others, although it may help at first, the headache soon comes back.
It may cause local bruising and backache which lasts for a few days. Epidurals do not cause long term backache.
Difficulty in passing urine, severe pain or loss of feeling in the back or legs are not normal. If you get any of these you should contact your anaesthetist or another doctor at once.
Infection or bleeding into the back are very rare complications of epidurals, spinals and blood patches. There are other treatments. None has been shown to be as effective as a blood patch. You can talk about this with your anaesthetist.
Anaesthetics Department
Borders General Hospital
Melrose
TD6 9BS
Adapted from a leaflet from The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland (Second edition December 2003)