A Complete Guide to Spinal Headache

Medically Reviewed By Susan W. Lee, DO

A spinal headache develops when cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks. It often occurs as a complication of a lumbar puncture, but injury and surgery can also be responsible. CSF is a liquid that circulates through and around the brain and spinal cord. It serves many purposes, including balancing pressure in the head, transporting nutrients, and supporting key structures.

If you experience a CSF leak, you may develop a spinal headache.

Read on to learn more about spinal headaches, including their symptoms, causes, treatment, and prevention.

Key facts about spinal headaches

  • A spinal headache is when CSF leaks from a puncture wound. It is also known as a postdural puncture headache.
  • Spinal headaches can be caused by medical procedures and injury to the spinal cord or head.
  • Symptoms of a spinal headache include head pain that worsens when upright.
  • Spinal headaches often go away on their own, but treatment can help alleviate symptoms and support recovery.

Causes of spinal headaches

Someone closes their eyes and rests their head in their hands.
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Spinal headaches are caused by Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source CSF leaking from the spinal cord. This happens as a result of puncturing the spinal dura — a tube-like membrane that surrounds the spinal cord.

Punctures and CSF leaks can happen due to:

  • procedures that involve puncturing the dura on purpose, such as:
    • a spinal tap or lumbar puncture procedure
    • spinal injections, such as giving epidural anesthesia
  • injury to the brain or spine
  • brain or spinal surgery
  • spinal conditions, such as spinal meningeal diverticula, whereby the dura or other structures around the spinal cord bulge outward

Sometimes CSF leaks happen spontaneously Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , or without an obvious cause. Researchers are still investigating why spontaneous CSF leaks happen, but they may be linked to having a weak dura.

CSF leakage reduces pressure around the brain, causing pain by:

  • causing traction on sensitive structures such as the blood vessels and nerves
  • slight sagging of the brain
  • dilation and inflammation of blood vessels, glands, and other structures in the head

Learn more about lumbar punctures, including their procedure and safety.

Risk factors for spinal headaches

Several factors can increase the risk of developing a spinal headache, including Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • being assigned female at birth
  • being pregnant
  • being ages 20 to 40 years
  • having a systemic illness — whereby you have symptoms that affect multiple body systems, such as diabetes
  • having a history of headaches, especially previously experiencing spinal headaches
  • having a lower body mass index (BMI)
  • being dehydrated

Some risk factors relate to the way a spinal procedure is done. For example, the following factors may also raise the risk of a spinal headache:

  • using a larger needle or large bore spinal needle
  • using a needle with a cutting tip
  • inserting the needle in a certain way
  • removing large amounts of CSF
  • the number of punctures needed to carry out the procedure
  • the physician having less experience

Symptoms of spinal headache

One of the main spinal headache symptoms is head pain at the front or lower back of the head. Your headache may feel worse Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source when standing upright or sitting, and improve when lying down.

Other symptoms that may accompany a spinal headache include:

When to see a doctor

Contact a doctor as soon as possible if you experience any of the following symptoms or factors:

  • your symptoms are persistent or frequent
  • your headache symptoms change or worsen
  • you have recently had an injury or medical procedure to the spine, neck, or head
  • you have neurological symptoms alongside a headache, such as:

Some symptoms that occur due to a spinal headache are shared with other, serious conditions that require urgent care.

Call 911 for any of the following symptoms alongside a headache:

  • severe or sudden head pain
  • feeling like you have the worst headache of your life
  • stiff neck
  • loss of consciousness
  • weakness or loss of sensation in any part of the body
  • vision or hearing changes

Read more about when to contact a doctor or 911 for a headache.

Diagnosing a spinal headache

To diagnose the cause of your headache, a doctor will ask about your symptoms and medical history. If you have recently had any medical procedures or injuries, make sure to let them know.

Often, doctors can diagnose a spinal headache and rule out other conditions based on your symptoms and medical history.

However, your medical team may order further tests if your symptoms are persistent, severe, or do not improve when lying down. Extra tests can include imaging scans of the head, such as an MRI or CT scan, and blood tests.

Treatment and management options for spinal headache

Treating a spinal headache can involve a combination of medical approaches and self-care or at-home management.

Medical treatments

Doctors may first recommend treatments that help alleviate your symptoms, as many spinal headaches eventually go away on their own Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . Examples of these treatments include:

  • prescription or over-the-counter pain relievers
  • hydration with intravenous (IV) fluids, fluid given into a vein
  • caffeine, which you can drink, such as in coffee, or doctors can give through an IV

Always talk with a doctor or pharmacist before taking any new medications or remedies, even if they are available over the counter.

In some cases, you may need treatment to resolve the underlying cause of the spinal headache, such as:

  • Epidural blood patch: An epidural blood patch involves injecting a small sample of your own blood into the area in the back where the puncture is. This creates a clot that can help seal the puncture, preventing further CSF leakage and stopping the headache. However, in rare cases, it may lead to side effects such as pain or irritation, infection, and nerve compression.
  • Saline infusion: Rarely, doctors recommend a saline infusion through an IV. This may be less effective but have fewer side effects than a blood patch.
  • Surgery: If your spinal headache does not improve with other treatments, doctors may recommend surgery. Surgical procedures Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source for CSF leaks include repairing a dural tear, strengthening the dura, or tying off meningeal diverticula.

Self-care methods

Self-care methods are essential in managing a spinal headache alongside medical treatments. Options include:

  • staying hydrated, as dehydration can increase Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source the severity of headache symptoms
  • resting as much as possible
  • limiting physical activity according to your medical team’s advice
  • maintaining a horizontal position, such as by lying down

Outlook for spinal headaches

The outlook for spinal headaches is typically positive, but it can vary per person. For many people, spinal headaches go away on their own within 1 to 2 weeks Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

If your symptoms last longer, treatment can also help headaches go away.

However, in rare cases, people develop complications from spinal headaches or treatment, such as:

Talk with a doctor for personalized advice about outlook and recovery.

Preventing spinal headaches

Not all spinal headaches can be prevented.

However, in some cases, healthcare professionals can help reduce the risk of a spinal headache from a procedure by using certain strategies. For example, using smaller or non-cutting needles for lumbar puncture and epidural procedures if possible may lower risks.

Staying hydrated before and after the procedure may also help.

Summary

A spinal headache occurs when CSF leaks from the brain and spinal cord area. Leakages may be caused by procedures like a lumbar puncture or epidural injection, surgery, or injury.

Spinal headache symptoms include a headache in the front or lower back of the head that worsens when upright.

Treatment mainly focuses on relieving symptoms, as spinal headaches usually go away on their own.

Contact a doctor as soon as possible if you have a headache with concerning, severe, or persistent symptoms.

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Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2024 May 13
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