What to know about spinal headaches

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The symptoms of a spinal headache are much worse when a person sits up or stands up, and can improve with lying down flat.

People may experience a spinal headache as a bilateral frontal headache. This means the headache occurs on both sides of the front of the head.

Spinal headaches can also take the form of an occipital headache. These headaches generally start at the base of the head and then spread along a person’s scalp.

People often describe occipital headache pain as:

• shooting pain
• shocking pain
• throbbing pain
• burning pain
• aching pain

Other symptoms of a spinal headache may include:

• nausea
• neck pain
• dizziness
• visual changes
• tinnitus
• hearing loss
• numbness or tingling sensation in the arms

Spinal headaches occur when CSF leaks from the spinal cord, and it can occur due to a puncture during a medical procedure, or as a result of trauma or disease. This leak causes the support that the CSF provides around the brain to decrease.

A CSF leak may occur as a complication of a number of procedures, including the following procedures.

While these are the most common causes, sometimes a spinal headache can occur from a leak due to trauma, primary or metastatic spine cancer or spinal cord cancer, or after spine surgery. It has also rarely been reported after heavy lifting or without a known cause.

Lumbar puncture

During this procedure, a doctor takes a sample of CSF from a person’s spinal cord using a needle to diagnose certain conditions. Doctors sometimes refer to a lumbar puncture as a spinal tap.

A healthcare professional may use a lumbar puncture to diagnose:

• meningitis
• subarachnoid hemorrhage
• certain neurological disorders

Diagnostic myelography

A diagnostic myelography (myelogram) is a diagnostic procedure that a doctor can use to diagnose potential issues with a person’s spinal canal, which is the bony channel in the spine that protects the spinal cord and nerve roots.

During this procedure, a medical professional inserts a dye into a person’s spinal canal. They then use a CT scan or fluoroscopy to observe the dye within the spinal canal. Fluoroscopy is a type of medical imaging that uses a continuous X-ray to allow healthcare professionals to see moving images of an area in the body.

Subarachnoid block

During a subarachnoid block, a medical professional injects anesthetic medications into the fluid in the lower part of the spine.

This causes the person receiving the subarachnoid block to experience loss of feeling in the lower half of their body, allowing a doctor to perform certain medical and surgical procedures.

A subarachnoid block is often an effective alternative to general anesthesia when the site of the surgery is in the lower half of the body.

Epidural anesthesia

Epidural anesthesia is a technique that medical professionals use as a primary surgical anesthetic or as a resource for pain management after surgery. Healthcare professionals may also sometimes use epidural anesthesia to numb the pelvic area during childbirth.

During an epidural procedure, a medical professional injects anesthetic into the space that surrounds the spinal cord. This causes a person to experience numbness in the surrounding area to the injection site, usually around the abdomen or pelvic region.

A doctor will often diagnose a spinal headache using a clinical evaluation based on a person’s symptoms.

Healthcare professionals do not typically require imaging studies or laboratory tests to help them diagnose this condition. If a person’s spinal headache does not go away, doctors may then use imaging tests like CT and MRI scans to rule out other conditions.

The following steps may help a person manage the symptoms of a spinal headache:

• taking simple analgesics (pain relieving medications)
• oral or intravenous hydration
• avoiding being in an upright position

The symptoms of a spinal headache may also go away on their own without treatment.

If a person has spinal headaches that are severe or persistent, they may require further treatment.

A medical professional may treat severe spinal headaches with an epidural blood patch. During this procedure, a doctor will inject a small amount of a person’s own blood into their lower back to stop the CSF leak.

Research suggests that the success rate for an epidural blood patch is between 75–90%. In some cases a person may experience side effects from this procedure, which include:

• back pain
• radiculopathy, or damage to the nerves in the lower back
• bulbar neuropathy, or damage to the lower cranial nerves
• meningitis as a result of an infection
• hematoma, which is when an area of blood collects outside of the larger blood vessels
• cauda equina syndrome, which is when the nerve roots in the lumbar spine become compressed

The most common complication of an epidural blood patch is aseptic meningitis. Aseptic meningitis is an inflammatory reaction after the procedure. It causes severe head pain but differs slightly from a spinal headache because it does not worsen with standing up. Treatment for this complication may include an anti-inflammatory medication.

In some cases, a spinal headache can go away on its own within a few hours or several days.

In over two-thirds of people with spinal headaches, the symptoms resolve on their own within 1–2 weeks.

However, for many people, the symptoms can be severe and persistent. In this case, an individual may require medical intervention to help relieve the pain.

If a person experiences the symptoms of a spinal headache they should contact a doctor. This is because symptoms of a spinal headache may interfere with their daily life and can go away with treatment.

A person should also contact a doctor because ongoing headaches may also be a symptom of a more serious condition that may require treatment.

A person should seek immediate medical care if they:

• have a sudden, severe headache alongside a stiff neck
• have a severe headache that is not related to another condition alongside:
  • fever
  • nausea
  • vomiting
• have a headache alongside:
  • confusion
  • weakness
  • double vision
  • loss of consciousness
• have a headache that becomes worse over days or weeks or that changes in pattern or behavior over time
• have a headache and a loss of sensation or weakness in any part of the body, this may signal a stroke
• experience two or more headaches a week
• experience a headache in association with convulsions and/or shortness of breath
• have a history of cancer or HIV and AIDS, and experience new headaches
• experience a persistent headache despite previously being headache-free, particularly if they are over the age of 50

A spinal headache occurs when CSF leaks through a puncture in the membrane surrounding the spinal cord. This leak then causes the support that the CSF provides to the brain to decrease. This decrease in pressure causes a person to experience a spinal headache.

A CSF leak can occur as a side effect of certain medical procedures, such as a lumbar puncture, myelogram, subarachnoid block, the administration of epidural anesthesia, or a traumatic injury.

The main symptom of a spinal headache is a bilateral frontal or occipital headache. Other symptoms may include nausea, neck pain, dizziness, visual changes, and numbness or a tingling sensation in the arms. Spinal headache symptoms often become worse when a person stands upright.

A person may treat spinal headaches with analgesics, hydration, and avoiding being in an upright position. A doctor may treat more serious spinal headaches with an epidural blood patch.

People should speak with a doctor if they think they may be experiencing a spinal headache and seek immediate medical attention if they experience a sudden or severe headache.