8.4 Post spinal headache:
The most widely accepted explanation for the cause of head ache is that the leakage of CSF through the hole in the dura mater lowers the pressure in the subarachnoid space. When the patient assumes an upright position, there is traction on the dura, and blood vessels, resulting in pain. Traction placed upon the 6th cranial nerve may result in diplopia and tinnitus.
8.4.1 Features of a spinal headache
- The spinal headache is different from any the patient has experienced before.
- It is worse on sitting up. It is relieved by lying down.
- External stimuli, such as light and noise, make the headache worse.
- The headache is mainly at the back of the head (occipital) and is associated with pain down the neck.
- It is relieved by increasing abdominal pressure.
The incidence of spinal headaches is related to the size of the needle (Table 8:2) . Patients with the following characteristics are at increased risk: less than 50 years of age, female and pregnant.
Table 8:2 needle size & incidence of headache
| Needle size |
Incidence of headaches |
| 20G |
10–20% |
| 22G |
8–15% |
| 25G |
2–5% |
| 26G |
<1% |
8.4.2 Prevention and treatment of post spinal headache
Prevention
- Use a fine needle.
- Make sure the fibers of the dura mater are divided and not cut by adjusting the bevel of the needle.
- Avoid multiple punctures.
- Nurse the patient flat for 6 hours post-operatively.
- Avoid coughing and straining post-operatively.
Treatment of post spinal headache:
- Patients with spinal headaches prefer to remain lying flat in bed as this relieves the pain.
- They should be encouraged to drink freely or, if necessary, be given intravenous fluids to maintain adequate hydration.
- Caffeine containing drinks such as tea, coffee or Coca-Cola are often helpful.
- Simple analgesics such as paracetamol, aspirin or codeine may be helpful,
- Measure to increase intra-abdominal pressure such as abdominal binder may help.
- Sumatriptan, normally used in the treatment of migraine, is said to be effective.
- For prolonged severe head ache refer or consult seniors - this may be treated with epidural blood patch performed by aseptically injecting 15-20ml of the patient's own blood into the epidural space. This then clots and seals the hole and prevents further leakage of CSF.