Spinal Headache After a Spinal Tap – Watch Out for These Symptoms
One day in October, I woke up with a stiff neck and a headache that would not go away. I thought maybe I had slept funny or pulled a muscle the day before—and I tried to ignore how I was feeling. As the day went on, my headache and neck pain got worse. I decided to take my family to a park and get some fresh air. By the time we were walking back to our car, I was in so much pain I could barely walk, and I had come down with a high fever.
That night, I ended up in the E.R. Against my better judgement, I drove myself to the hospital because I didn't want to have to wake up my sleeping kids and husband. I barely made it there—I couldn't move my neck side to side and was violently shaking.
In the E.R. I was told I likely had meningitis, and a blood test was taken. After the blood test results were inconclusive, they suggested a spinal tap. Not sure what was going on, I conceded.
The spinal tap was nowhere near as painful as I expected—it was over quickly and I hardly felt a thing. I was told casually that I should lie on my back for at least 15 minutes following the procedure, and in my dazed state, they had me sign a consent form.
I received a probable diagnosis of viral meningitis and was instructed to follow up with my doctor the next day. (Viral meningitis is usually much less severe than the life-threatening bacterial meningitis). After getting IV fluids and pain medication, and while still lying down, I began to feel a little better. The nurse returned about 20 minutes after the procedure and said I was okay to go home. I told her I had driven myself, and she said I was fine to drive back home.
On the way home I quickly discovered I had made a mistake. I felt even more ill than I had when heading to the hospital. I developed a headache that I had never experienced before—it felt like my head was literally going to explode. When I finally did make it home, I collapsed on my front steps, screaming in pain.
The following week can only be described as a nightmare. I was unable to work, take care of my kids, or barely even lift my head long enough to get out of bed. It turns out, I had developed a spinal headache, which is a complication of spinal taps and epidurals. Although spinal headaches can happen regardless of the precautions taken after the spinal tap, I found out later that my case was most likely caused by what I did and didn't do afterwards. Had I had been advised to stay laying down longer, and not to drive myself home, I might not have had to endure the week of pain that I did.
After several trips to the doctor, and being prescribed three different pain medicines and told the headache would likely go away, I finally was able to get a blood patch procedure done to cure the headache. I was never more thankful for life and good health than I was at that moment. I had become so depressed during the week that I was not able to take care of my two daughters, and had to depend on my parents and husband for help.
I'm writing this article because I never want anyone to have to go through what I did. Whether you have meningitis or another disorder that calls for a spinal tap as a diagnosis, you definitely don't want this headache on top of everything else. Find out what to watch out for and how to avoid going through what I had to.
What is a Spinal Tap, and Who Needs One?
A spinal tap, also known as a lumbar puncture, is a medical procedure through which cerebrospinal fluid is extracted from the spinal canal to be tested for certain diseases. While other conditions might be tested for via lumbar puncture, the most common reason a doctor may order one is to help diagnose meningitis, a serious infection of the meninges (protective membranes around the spinal cord) that can lead to permanent disability or death if not treated immediately. If someone arrives at a hospital with symptoms indicative of meningitis, such as sore neck, severe headache, and high fever, a spinal tap will probably be done right away.
Other Tests May Make a Spinal Tap Unnecessary
Lumbar punctures can confirm a meningitis diagnosis, and can aid in deciding what is the appropriate course of treatment. There are other ways, however, for medical professionals to determine whether or not meningitis is likely. Simple physical tests can often indicate whether certain flu-like symptoms may actually be something more serious. Doctors may test for Brudzinski’s sign, in which your hips and knees flex automatically if a stiff neck is manually forced to turn side to side. Another physical test used is Kernig’s sign, where if you attempt to extend your leg, you experience pain in your thigh.
Often times, a blood test will be done when you arrive to the hospital with signs of meningitis. Sometimes the combination of a high white blood cell count and severe enough symptoms, doctors will begin treatment for meningitis without the confirmation of a spinal tap. In many of these cases they are reasonably certain the disease is present, and treating without waiting for other testing is deemed appropriate in order to save the patient’s life.
Usually, tests such as these, along with an evaluation of other symptoms, is done first when you arrive at the hospital. If you have some symptoms of meningitis but not others, and score negative on both physical tests along with no elevated white blood cell count, your doctor may be able to reasonably rule out the disease. Some may order a spinal tap even if not all arrows are pointing to meningitis, just to cover all their bases.
If You Do Get a Spinal Tap, You Need to Do These Things
If you do end up getting a lumbar puncture procedure, it is extremely important to understand it, what to do afterwards, and what the potential consequences may be. Spinal taps often bring frightful images to mind. Contrary to their reputation for being extremely painful, the procedure itself usually hurts about the same as a standard blood test. You may feel weakness in your lower body and a sense of pressure, but it is over with relatively quickly.
What you need to watch out for is what can happen immediately after a spinal tap, and in the following days and weeks. If proper care is not taken afterwards, you could be setting yourself up for serious medical problems, whether or not your test confirms meningitis.
The following two guidelines must be adhered to immediately after the procedure:
Lay down flat on your back immediately following the procedure, and stay that way for as long as possible.
Some literature given during discharge at hospitals says it’s only necessary to lay down for 20 minutes, but it is best that you stay on your back for at least an hour. For the 24 hours following the spinal tap you should only get up to eat and drink or to use the restroom. Do not drive yourself home from the hospital, do not go to work the next day, do not attempt to take care of small children by yourself. Rest for at least one full day, even if you are feeling good.
During the spinal tap a small puncture was made in the membranes surrounding your spinal cord, and cerebrospinal fluid can slowly leak from that hole. Staying as hydrated as possible can ensure that pressure is maintained to make up for that small loss of fluid.
What is a Spinal Headache?
Unfortunately, these two guidelines are not always followed. Even when they are adhered to, a spinal headache may still occur after the test. A spinal headache, or post-dural headache happens when the puncture made during the spinal tap remains open, and small quantities of cerebrospinal fluid leak through the hole. The headache can vary in severity from mild to debilitating. It is characterized by being much worse when standing upright, and almost completely disappearing while laying down. This is because of the change in pressure of cerebrospinal fluid: when standing up the pressure drops, and when lying down the pressure is normalized. It is estimated that over 40% of patients who receive a spinal tap end up suffering from a spinal headache.
Watch Out for These Symptoms
Some spinal headaches can appear later, up to 5 days after the spinal tap, but most start within a half hour of the procedure. You’ll know it’s coming on if:
- You feel fine while laying down, but have a severe headache when upright
- You begin experiencing migraine symptoms such as stiffness and sensitivity to light
- Pain medication is of little to no help
If you do experience these symptoms following a spinal tap, especially a headache that gets immediately better while lying down, call your doctor right away. You probably have a spinal headache.
Complications – What Happens if it is Left Untreated?
Some spinal headaches go away left untreated. Over the course of a few days the puncture in the spinal membrane closes and the fluid pressure returns to normal. A large number do not heal on their own. Because most of these headaches are quite severe and interfere with normal everyday functions, most patients whose headache does not go away will end up seeking treatment within a few days or weeks. In the case that someone waits too long to see if the headache will get better on its own, devastating consequences can result. Leaking cerebrospinal fluid can lead to brain hemorrhage, blindness, and in some cases, dementia.
Treatment with a Blood Patch Procedure
The most common effective treatment for spinal headaches is called a blood patch or epidural patch. This procedure is actually more invasive, time consuming, and uncomfortable than the original spinal tap. To perform a blood patch a medical professional, in many cases a pain management specialist, will draw blood from your arm, and then inject it into the area on your back where the original puncture was. The goal is for that blood to form a clot or “patch” that is able to plug the leak and seal the original puncture, thus preventing further loss of cerebrospinal fluid. This procedure is usually done using only a local anesthetic, but some patients may opt to be fully asleep.
After the procedure, many people experience lower back discomfort and difficulty turning or walking for the first 12-24 hours. Relief from the headache, however, is sometimes immediate. Some who have been suffering for many days from the spinal headache describe the procedure as a “miracle” cure because they are able to feel the results so quickly.
How to Cope While Waiting for the Blood Patch
Sometimes you may not be able to get an emergency blood patch done, and may have to schedule it out a few days. For patients with extremely severe spinal headaches, this can be devastating. To help make it through those painful hours or days until you can have the procedure done, the following suggestions may offer some relief:
- Pain medication: Some prescription pain relievers may numb the effects of the headache. Talk to your doctor if you absolutely cannot stand the pain.
- Caffeine: Caffeine shrinks the blood vessels, lessening the severity of some headaches. It can provide some relief for a spinal headache if used in conjunction with these other guidelines. Many discharge paperwork from hospitals after a spinal tap was done actually encourage caffeine intake to be increased to stave off the headache.
- Stay laying down: This is the single most effective way to alleviate a spinal headache in the short-term.
- Rest in a dark room: A dark, quiet room can calm you and allow you to rest.
- Hydration: Taking in as many fluids as possible can help replenish some of the leaking cerebrospinal fluid.
- Arrange child or pet care.
Hang in there if you have to wait for the blood patch. Severe spinal headaches can cause depression or even suicidal thoughts if you are enduring pain you absolutely can’t stand. If you simply cannot bear the pain, or have thoughts of harming yourself, seek emergency medical help.
If you find yourself with symptoms of meningitis, you need to seek medical attention as soon as possible. Diagnosis and treatment early on can help save your life. If meningitis cannot be ruled out and you must undergo a spinal tap, proceed with extreme caution and follow the above guidelines to avoid the painful spinal headache.