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Understanding Headaches After Spinal or Epidural Anaesthesia

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This leaflet provides information about headaches that can sometimes occur after spinal or epidural anaesthesia. It's designed to help you understand what might be happening and what to do.

What is Spinal or Epidural Anaesthesia?

  • Spinal Anaesthesia: A single injection of local anaesthetic into the lower back, numbing the lower body. Often used for childbirth, hip or knee surgery.
  • Epidural Anaesthesia: A thin tube (epidural catheter) is placed in your back, allowing pain relief to be given continuously. Commonly used for labour pain relief and some surgeries.

What is a Dural Puncture Headache?

A dural puncture headache (sometimes called a spinal headache) is a specific type of headache that can occur after certain types of spinal or epidural anaesthesia.

What Does a Dural Puncture Headache Feel Like?

  • Severity: It can be quite severe.
  • Location: Typically felt at the front or back of your head.
  • Worsening Factors: It often gets worse when you sit or stand up and improves when you lie down.
  • Associated Symptoms: You may also experience:
    • Neck pain or stiffness
    • Nausea
    • Sensitivity to light (photophobia)

How Common are Dural Puncture Headaches?

  • It's relatively uncommon.
  • Approximately 0.5 to 1 in every 100 people who have a spinal or epidural anaesthetic will experience a dural puncture headache.
  • People having spinal or epidural anaesthesia for childbirth are slightly more likely to develop this type of headache.

What Causes a Dural Puncture Headache?

  • Your brain and spinal cord are surrounded by a fluid-filled sac called the "dural sac."
  • During a spinal anaesthetic, a needle is deliberately inserted through the dural sac to deliver the anaesthetic.
  • During an epidural, the needle usually avoids the dural sac, but sometimes it can accidentally pierce it.
  • If this happens, a small hole is created, and some of the fluid can leak out, reducing the pressure around your brain and spinal cord.
  • Sitting or standing increases the leak, making the headache worse. Lying down increases the pressure and can ease the headache.

What Should I Do If I Develop a Headache?

Initial Self-Care (First 24-48 Hours):

  • Pain Relief: Take over-the-counter pain relievers like paracetamol or ibuprofen (follow package instructions).
  • Hydration: Drink plenty of fluids.
  • Caffeine: Caffeinated drinks (coffee, tea, cola) may help some people (discuss with your healthcare provider if you have any concerns).
  • Rest: Avoid straining or lifting anything heavier than your baby.
  • Position: Lie down as much as possible.

When to Seek Medical Attention:

Contact your midwife, hospital team, or visit an emergency service if:

  • Your headache doesn't improve with over-the-counter pain relief.
  • Your headache gets worse.
  • You can't care for your baby or do normal daily tasks.
  • You experience vision or hearing problems.
  • You feel sleepy, sick, or confused.

Epidural Blood Patch (EBP) – A Possible Treatment

If your headache persists and doesn't respond to initial self-care, your healthcare team may suggest an Epidural Blood Patch (EBP).

  • What is it? A small amount of your own blood is injected into the same area of your back where the spinal or epidural was given. This helps to seal the small hole in the dura and stop the fluid leak.
  • Time Estimate: The procedure itself takes approximately 15-30 minutes. You will need to lie flat for at least 1-2 hours afterwards.
  • Effectiveness: Approximately 60-70 out of every 100 people who have an EBP feel better.
  • Timing: Evidence suggests that an EBP is most effective if performed 48 hours or more after the headache starts.

Risks and Side Effects of an Epidural Blood Patch

  • Discomfort: The procedure may be uncomfortable.
  • Bruising: You may experience bruising at the injection site.
  • Backache: Backache and stiffness can occur and may last for a few weeks.
  • Further Puncture: There's a small risk of another puncture to the dura, which could worsen the headache (this risk is similar to the initial dural puncture).

Seek Immediate Medical Attention After an EBP if you experience:

  • Difficulty passing urine
  • Difficulty controlling your bowel movements
  • Severe back pain
  • Loss of feeling or movement in parts of your body
  • Feeling unwell with a fever
  • Pus or redness around the injection site

Frequently Asked Questions (FAQ)

  • Q: Will I definitely get a headache?
    • A: No, most people do not experience a dural puncture headache.
  • Q: How long will the headache last?
    • A: It can vary, but it usually lasts between a few days and a couple of weeks.
  • Q: Can I take my usual medications?
    • A: Discuss this with your healthcare provider.
  • Q: Is there anything I can do to prevent a headache?
    • A: There's no guaranteed way to prevent it, but following your healthcare provider's instructions carefully can help.

Glossary

  • Anaesthesia: Loss of sensation, usually achieved with medication.
  • Dura: A tough membrane surrounding the brain and spinal cord.
  • Dural Sac: The fluid-filled sac containing the brain and spinal cord.
  • Epidural: A space outside the dural sac where medication can be given.
  • Photophobia: Sensitivity to light.