Headache after epidural analgesia or a spinal anaesthetic

Your brain and spinal cord are contained in a bag of fluid. The bag is called the dura and the fluid is called the cerebrospinal fluid (CSF).

When an epidural is given, a needle is used to inject local anaesthetic just outside the dura. In about 1 in 100 patients, the needle accidentally passes through the dura.

When a spinal is given, a very fine needle is inserted through the dura deliberately to inject local anaesthetic into the CSF.

If too much fluid leaks out through this hole in the dura, the pressure in the bag of fluid is reduced. When you sit up or stand, the pressure around your brain is reduced even more. This decreased pressure can cause the symptoms typical of a post dural puncture headache.

Some patients describe it as like a very bad migraine which is made worse when sitting or standing up.

The hole in the dura will usually mend itself in a few weeks, but it can take longer.

Lying flat and taking simple pain relieving drugs (such as paracetamol and dihydrocodeine) may help. You should drink plenty of fluid (some people find caffeine-containing drinks especially helpful) and avoid lifting and straining.

A severe post dural puncture headache will often need to be treated by an ‘epidural blood patch’.

Being given a blood patch is like having an epidural and takes about half an hour. The anaesthetist will take some blood from a vein in your arm and inject it into your back near the hole in the dura where it will clot. This will tend to plug the hole and help the hole to heal.

A blood patch will usually cure the headache within 24 hours. After this period, if you still have a headache, it may be worth repeating the blood patch once more. It is very rare to need more than two blood patches. Your anaesthetist will discuss this with you.

After a blood patch, we recommend that you lie flat in bed for two hours and do not lift anything heavy for at least two days.

You may need someone at home with you to help you with your daily activities.

There is a chance that another accidental dural puncture could occur.

A blood patch may not cure your headache. In about 60 – 70% of patients, a blood patch will take away the headache very quickly.

In the others, although a blood patch may help initially, the headache soon returns.

‘...when it finally worked, the blood patch was wonderful…’

A blood patch may cause local bruising and backache which lasts for a few days. Epidurals do not cause chronic long-term backache.

‘...I was back to normal very quickly, but my back was stiff for quite a while…’

Infection or bleeding into your back are very rare complications of epidurals, spinals and blood patches.