Spinal Headaches

Most people have experienced regular headaches, but spinal headaches represent a distinct and often misunderstood medical condition that requires special attention. These headaches typically occur after certain medical procedures and can significantly impact daily activities. This comprehensive article explores the key aspects of these severe headaches, including their symptoms, causes, prevention methods, and cure for spinal headaches. 

What are Spinal Headaches?

A spinal headache develops when there's a decrease in the amount of cerebrospinal fluid (CSF) surrounding the brain. This special fluid plays a key role in protecting and nourishing the brain and acting as a cushion against sudden movements.

The condition typically occurs when CSF leaks through a small puncture in the protective membrane (called meninges) that surrounds the spinal cord. This leakage can happen following certain medical procedures, particularly after a spinal tap or epidural anaesthesia.

Doctors recognise this condition by several names:

• Post-dural puncture headaches
• Epidural headaches
• Low-pressure headaches
• Understanding CSF's Role: The cerebrospinal fluid serves multiple essential functions:
• Provides nutrients to the brain
• Creates a protective cushion around the brain and spinal cord
• Supports the brain during movement
• Maintains proper pressure in the skull

Symptoms of Spinal Headaches

The following are several distinctive spinal headache symptoms:

• An intense dull or throbbing pain affecting either the front or back of the head
• Pain that significantly worsens when sitting or standing upright
• Headache intensity that increases with coughing, sneezing, or straining
• Nausea and dizziness
• Neck pain or stiffness
• Vision changes and heightened sensitivity to light
• Seizures

What makes spinal headaches particularly distinctive is their positional nature - the pain typically improves when a person lies down flat. This characteristic helps doctors distinguish spinal headaches from other types of headaches.

Less Common Manifestations: Some patients may experience additional, less frequent symptoms:

• Tinnitus (ringing in the ears)
• Temporary hearing loss
• Tingling or numbness in the arms (radiculopathy symptoms)

Spinal Headache Causes

The primary cause of spinal headaches stems from an accidental puncture of the dura mater, the protective membrane surrounding the spinal cord and brain. This typically occurs during common medical procedures such as epidural injections, lumbar punctures, or specific types of spinal surgeries. Even though epidural anaesthetics are injected outside the membrane surrounding the spinal cord, accidental punctures of that membrane can result in spinal headaches.

Several medical conditions can also trigger spinal fluid leaks, including:

• A ruptured cyst on the spinal cord
• A tear in the spinal cord meninges
• Head or face injuries, particularly fractured skulls

Risk Factors 

The likelihood of developing a spinal headache increases with certain risk factors:

• Individuals between 20 and 40 years of age
• Being pregnant
• Dehydration
• Systemic illnesses affecting the whole body
• Previous history of headaches
• Low body mass index (BMI)
• Undergoing procedures involving larger bore or cutting spinal needles

Complications of Spinal Headaches

In severe cases, mainly when left untreated, spinal headaches can develop into more serious conditions:

• Cerebral venous sinus thrombosis (blood clots in brain vessels)
• Subdural hematoma (bleeding in the skull)
• Seizures
• Brain herniation (increased pressure causing brain tissue displacement)
• Hypopituitarism (decreased hormone production)
• Syringomyelia (fluid-filled cyst in the spinal cord)

Diagnosis

For patients who have undergone a spinal tap within the past 14 days, the diagnosis is typically straightforward and usually doesn't require additional testing.
Diagnostic Methods Include:

• Detailed physical examination
• Assessment of pain patterns and movement limitations
• Evaluation of associated symptoms like dizziness and nausea
• Review of recent medical procedures
• Magnetic resonance imaging (MRI) when necessary

Spinal Headache Treatments

Doctors typically start with the least invasive methods before considering more aggressive treatments.

• Conservative Treatment Approaches: The initial treatment plan focuses on simple, non-invasive methods patients can implement at home. Doctors recommend several key strategies:
  • Maintaining a flat lying position for at least 24-48 hours
  • Increasing fluid intake significantly
  • Consuming caffeine-rich beverages
  • Taking over-the-counter pain relievers
• Invasive Treatment Approaches: 
  • Doctors may recommend more targeted interventions if these conservative measures don't provide relief within 24 hours. The most effective treatment for persistent spinal headaches is an epidural blood patch. 
  • In rare instances where the epidural blood patch proves ineffective, surgical intervention might be necessary to seal the spinal fluid leak. 

When to See a Doctor

• Patients should seek emergency treatment if they:
• Experience difficulty urinating
• Lose sensation in their back or legs
• Develop a sudden, severe headache with neck stiffness
• Notice any weakness in any part of the body
• Have a headache accompanied by fever, nausea, or vomiting

Additional Warning Signs: Medical evaluation is also necessary if patients notice:

• Headaches that worsen over days or weeks
• Changes in headache patterns
• Two or more headaches per week
• Persistent headaches in individuals over 50 who were previously headache-free

Prevention

The most effective preventive measure lies in the hands of doctors who perform spinal procedures.

Doctors can significantly reduce the risk of spinal headaches by using specialised equipment during procedures. The key preventive tool is a non-cutting needle or atraumatic needle, which creates a smaller puncture in the spinal membrane, reducing the likelihood of cerebrospinal fluid leakage.

Conclusion

Spinal headaches present unique challenges that set them apart from regular headaches. Their distinctive positional nature - pain that worsens when sitting or standing - makes them easier to identify, though proper medical evaluation remains essential for accurate diagnosis.

Medical advances have significantly reduced the risk of spinal headaches through improved equipment and techniques. Most patients recover fully within two weeks when they receive appropriate treatment, whether through conservative methods like bed rest and hydration or medical interventions such as epidural blood patches.
Doctors play an essential role in preventing and treating spinal headaches. Their expertise helps minimise risks during spinal procedures and ensures proper management if symptoms develop. 

FAQs

1. How common are spinal headaches?

Studies indicate that spinal headaches occur in approximately 10% to 40% of patients who undergo lumbar puncture procedures. The frequency varies depending on the type of needle used and the specific procedure performed. With modern techniques and equipment, the incidence has significantly decreased, mainly when doctors use specialised needles.

2. How long does a spinal headache last?

Most spinal headaches typically resolve within a few hours to a few days. However, doctors recommend seeking medical attention if symptoms persist beyond 24 hours. In some cases, these headaches can last up to two weeks without proper treatment, though this is relatively uncommon.

3. At what age do spinal headaches start?

Spinal headaches most commonly affect individuals between 20 and 40 years of age. This age group is particularly susceptible, with pregnant women being at higher risk due to the frequent use of epidurals during labour. The condition is less common in older adults and children.

4. Which doctor to consult for spinal headache?

Patients should first consult their primary physician, who can refer them to appropriate specialists. For spinal headaches following medical procedures, the doctor who performed the procedure should be contacted first, as they are familiar with the patient's medical history.

5. What are the effective spinal headache treatments at home?

The following are several home remedies for spinal headache symptoms:

• Maintaining a flat lying position
• Increasing fluid intake significantly
• Consuming caffeinated beverages
• Taking over-the-counter pain relievers as recommended
• Avoiding activities that worsen symptoms

Dr. Ashish Bagdi

MBBS, MD (Medicine), DM (Neurology)
CARE CHL Hospitals, Indore

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