Spinal headaches causes, diagnosis, treatment

Spinal headaches occur in up to 30 percent of the people who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both these procedures require a puncture in the tough membrane that surrounds the spinal cord.

During a spinal tap, a sample of cerebrospinal fluid is withdrawn from your spinal canal. During spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache.

Most spinal headaches — also known as post-lumbar puncture headaches — resolve on their own with no treatment. However, spinal headaches lasting 24 hours or more may be treated.

Signs and symptoms

Spinal headaches vary in intensity from mild to incapacitating. The pain typically gets worse when you sit up or stand and decreases or goes away when you lie down.

Spinal headaches are often accompanied by:

  • Dizziness
  • Ringing in the ears
  • Nausea
  • Visual changes

Risk factors

Spinal headaches are more common in women and in people who have a history of experiencing headaches in general. Spinal headaches occur most often in people between the ages of 20 and 40. The risk of spinal headaches increases with use of larger needles and multiple punctures in the membrane that surrounds the spinal cord.


Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache.

Spinal headaches typically appear within 12 to 24 hours after a spinal tap or spinal anesthesia. Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthesia is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is inadvertently punctured.

Screening and diagnosis

The doctor will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures — particularly a spinal tap or spinal anesthesia.

Sometimes the doctor will recommend a magnetic resonance imagining (MRI) exam to exclude other causes of the headache. During the exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.


Treatment for spinal headaches begins conservatively. Your doctor may recommend bed rest and oral pain relievers. If your headache hasn’t improved within 24 hours, your doctor may suggest one or more of the following treatments:

  • Epidural blood patch. Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache.
  • Intravenous caffeine. Delivered directly into your bloodstream, caffeine helps relieve spinal headaches — usually within a few hours — by constricting blood vessels within your head.
  • Epidural saline. Injecting a saltwater solution into the space outside the membrane that covers your spinal cord may put pressure on the lumbar puncture site and stop the cerebrospinal fluid leak. But because saline solution is absorbed so quickly by the body, spinal headaches often recur after this treatment.