Spinal Headache

If you're expecting a baby, whether you have a vaginal birth or a Cesarean section, you may choose to have epidural anesthesia when you give birth. This type of anesthesia is very safe: The most common side effect is shaking as the numbness wears off. But sometimes—although rare—an epidural can result in a temporary but severe headache.

This head pain is commonly referred to as a spinal headache because it also is a potential side effect of spinal anesthesia (rarely used in childbirth anymore) and a diagnostic procedure called a spinal tap. The more formal term for a spinal headache is post-dural puncture headache.

Only 1% of pregnant people develop a spinal headache after having an epidural. Research shows the incidence is higher—about 4%—among those who are obese. But if it happens to you, here's what you should know about why you have head pain, how long it will last, and how to get relief.

Spinal Headache Causes

To understand how head pain can occur after an epidural, you first need to understand why this type of anesthesia is given and how. The purpose of an epidural is to block sensation in the lower part of the body to lessen the pain of contractions and childbirth.

It's done by injecting an anesthetic medication (or a combination of such drugs) through a catheter placed in a small area just outside the spinal cord in the lower back called the epidural space. In order to insert the catheter, a needle is first inserted into the back.

There's a very small chance that when the needle goes in it might pierce the dural sac which encases the spinal cord and the cerebral spinal fluid that surrounds it. If fluid leaks from the tiny puncture, the pressure inside of the dural sac will change temporarily, resulting in a headache. The risk of this happening during an epidural is about 1 in 100.

What It Feels Like

Usually, a spinal headache doesn't occur until a day or more after an epidural, so you may already be home with your new baby if you get one. Spinal headache pain tends to be a dull, throbbing pain that can vary from mild to incapacitating.

It tends to get worse when you sit up or stand, but lessens dramatically when you lie down. It has been described by many people as the worst headache they have ever experienced.

If you develop a spinal headache, you might also experience other symptoms, such as dizziness, ringing in the ears (tinnitus), hearing loss, blurred or double vision, nausea, and neck stiffness.

Prevention and Treatment

Before inserting the needle into your low back, you'll be asked to curve your upper body forward while sitting or to lie on one side and curl into a fetal position so that your spine is visible and accessible.

Your job will be to hold extremely still so that the anesthesiologist can be as precise as possible in placing the needle. Your participation in this part of the process can help prevent a slip of the needle that could puncture the dural sac.

That said, accidents happen. Although a puncture of the dural sac during an epidural is extremely rare, if it happens to you and you wind up with a spinal headache, it can be treated until it resolves on its own, which can take a couple of weeks. Of course, you will have just given birth so don't hesitate to ask for extra help with the baby.

• Drink plenty of fluids.
• Lie flat as much as possible to prevent changes in the pressure inside the dural sac that can bring on head pain.
• Sip coffee or tea—caffeine sometimes can help relieve head pain.
• Take over-the-counter pain relievers, but ask a healthcare provider which are safe to take and at what dose, especially if you are breastfeeding.
• Try not to lift anything heavy and have someone pick up the baby and bring them to you to feed or hold.

If your headache is severe you may need to be treated with an epidural blood patch, in which some of your own blood is injected into the dural sac near the puncture. This will help speed healing of the puncture by creating a clot to help plug the hole and stop the leakage of cerebral spinal fluid.

For most people, this procedure will clear up a spinal headache within 24 hours, allowing them to go about the business of caring for their new baby without the distraction of head pain.