Postdural puncture headache, commonly known as a "spinal headache", can occur after certain regional anesthetic and diagnostic procedures. These include spinal anesthetics and myelographic x-ray diagnostic procedures. Rarely they can occur after epidural anesthetics or epidural steroid injections.

Spinal headache can occur when the fluid filled sac that surrounds the brain, spinal cord and its branches is punctured. The leak of fluid out of the sac in the lower back occasionally causes stretching of pain sensitive tissues in the head, which leads to headache.

Patients with spinal headache usually complain of pain which is worse in the upright position and minimal or absent when lying down. When symptoms are severe, double vision, nausea or vomiting may also occur.

These headaches typically resolve within a few days. Initial treatment is conservative. Patients are placed at bed rest and are given analgesics for discomfort. Drinking fluids, particularly caffeinated beverages also help.

If symptoms have not improved after several days of conservative treatment, an EPIDURAL BLOOD PATCH is performed. This provides relief of pain quickly in almost all cases of severe spinal headache.

An epidural blood patch is performed with the patient lying on his or her side in a comfortable position. The lower back is prepped in the area of the original procedure and local anesthetic is injected into the skin. A sterile needle is placed into the epidural space, in an area adjacent to the original sac puncture.

Blood is then withdrawn under strict sterile conditions from a vein in the patient's forearm or hand and is injected into the epidural space. The blood clots and acts as a "patch" against further leakage of spinal fluid through the puncture. The procedure is not painful but patients may occasionally experience temporary low back or neck pressure sensations for a short period after injection.