Materiały źródłowe

• #1 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #2 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #3 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  Postdural puncture headache (PDPH) remains a major concern after spinal anesthesia and is known to complicate 0.5% – 24% of cases. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid (CSF). A decline in CSF pressure leads to traction on pain-sensitive parietal dura and intracranial structures, thereby causing subsequent headache in patients. In these cases, the rate of CSF loss through dural perforation is greater than the rate of CSF production, especially when the needle size is larger than 25G. […] Gadoliniumenhanced magnetic resonance imaging (MRI) in PDPH frequently indicates the sagging of intracranial structures. MRI may also signify meningeal enhancement, which could be due to vasodilatation of thinwalled vessels in response to intracranial hypotension. Although finer needles have been used in recent years, the incidence of PDPH has not significantly decreased. In this regard, Grant et al. by using MRI showed a major decline in intracranial CSF volume after lumbar puncture, which was frequently associated with PDPH; however, some patients developed PDPH with relatively little alterations in the intracranial CSF volume.

• #4 The pathophysiology of lumbar puncture headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11701146/

  The pathophysiology of lumbar puncture headache (LPH) is still unclear. There is evidence that leakage of cerebrospinal fluid (CSF) leads to CSF hypotension, which causes dilation of intracranial veins, resulting in LPH. […] We propose the hypothesis that LPH is caused by an abnormal distribution of craniospinal elasticity. Increased compliance at the lumbar end of the spinal CSF space, resulting both from anatomic joining of the subarachnoid to the epidural space and from reduced CSF filling pressure, causes the hydrostatic indifferent point to move caudally, creating additional intracranial hypotension and venous dilation in the erect position. […] The near absence of LPH in the very young and in the elderly relates to the relative stiffness of the epidural space at these ages. Epidural injections of blood or saline give immediate relief by reducing epidural distensibility.

• #5 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #6 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #7

  https://healthmatch.io/migraine/spinal-migraine

  The amount of CSF leaking after a lumbar puncture is directly proportional to the size of the dural tear. […] To reduce spinal headaches after lumbar puncture, using noncutting (atraumatic) needles is recommended. […] The more lumbar puncture attempts, the larger the size of dura damage and the more the likelihood of spinal headache.

• #8 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Several factors contribute to the development of headache after lumbar puncture, including needle size, needle design, direction of the bevel, and number of LP attempts. […] Modifiable risk factors of PDPH include needle size, needle shape, bevel orientation and insertion angle, stylet replacement, and operator experience. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. […] The smaller needle diameter reduces the incidence of PDPH. […] However, multiple dural punctures caused by unsuccessful puncture would increase the rate of PDPH. […] Needle design variables, such as the needle size and needle shape, have been modified to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF.

• #9 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Several factors contribute to the development of headache after lumbar puncture, including needle size, needle design, direction of the bevel, and number of LP attempts. […] Modifiable risk factors of PDPH include needle size, needle shape, bevel orientation and insertion angle, stylet replacement, and operator experience. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. […] The smaller needle diameter reduces the incidence of PDPH. […] However, multiple dural punctures caused by unsuccessful puncture would increase the rate of PDPH. […] Needle design variables, such as the needle size and needle shape, have been modified to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF.

• #10 Post-Spinal Headache: A New Possible Pathophysiology

  https://brieflands.com/articles/aapm-13562

  The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #11 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Three pathophysiologic mechanisms have been proposed: […] CSF hypotension results in compensatory meningeal venodilation and blood volume expansion, with headache caused by acute venous distention. This mechanism is consistent with magnetic resonance imaging (MRI) in several reported cases of PDPH.

• #12 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  Postdural puncture headache (PDPH) remains a major concern after spinal anesthesia and is known to complicate 0.5% – 24% of cases. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid (CSF). A decline in CSF pressure leads to traction on pain-sensitive parietal dura and intracranial structures, thereby causing subsequent headache in patients. In these cases, the rate of CSF loss through dural perforation is greater than the rate of CSF production, especially when the needle size is larger than 25G. […] Gadoliniumenhanced magnetic resonance imaging (MRI) in PDPH frequently indicates the sagging of intracranial structures. MRI may also signify meningeal enhancement, which could be due to vasodilatation of thinwalled vessels in response to intracranial hypotension. Although finer needles have been used in recent years, the incidence of PDPH has not significantly decreased. In this regard, Grant et al. by using MRI showed a major decline in intracranial CSF volume after lumbar puncture, which was frequently associated with PDPH; however, some patients developed PDPH with relatively little alterations in the intracranial CSF volume.

• #13 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache/print

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. […] Three pathophysiologic mechanisms have been proposed: […] CSF hypotension results in compensatory meningeal venodilation and blood volume expansion, with headache caused by acute venous distention. This mechanism is consistent with magnetic resonance imaging (MRI) in several reported cases of PDPH.

• #14 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Three pathophysiologic mechanisms have been proposed: […] CSF hypotension results in compensatory meningeal venodilation and blood volume expansion, with headache caused by acute venous distention. This mechanism is consistent with magnetic resonance imaging (MRI) in several reported cases of PDPH.

• #15 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  Postdural puncture headache (PDPH) remains a major concern after spinal anesthesia and is known to complicate 0.5% – 24% of cases. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid (CSF). A decline in CSF pressure leads to traction on pain-sensitive parietal dura and intracranial structures, thereby causing subsequent headache in patients. In these cases, the rate of CSF loss through dural perforation is greater than the rate of CSF production, especially when the needle size is larger than 25G. […] Gadoliniumenhanced magnetic resonance imaging (MRI) in PDPH frequently indicates the sagging of intracranial structures. MRI may also signify meningeal enhancement, which could be due to vasodilatation of thinwalled vessels in response to intracranial hypotension. Although finer needles have been used in recent years, the incidence of PDPH has not significantly decreased. In this regard, Grant et al. by using MRI showed a major decline in intracranial CSF volume after lumbar puncture, which was frequently associated with PDPH; however, some patients developed PDPH with relatively little alterations in the intracranial CSF volume.

• #16 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #17 Spinal Headaches | Arkansas Children’s

  https://www.archildrens.org/programs-and-services/neuroscience-center/headache-program/Conditions/spinal-headache

  A spinal headache is a severe headache caused by a cerebrospinal fluid leak, the fluid surrounding the brain and spinal cord. The loss of fluid leads to lower pressure in the skull, which causes the brain to sag. The tissues and nerves around the brain stretch, resulting in a headache. […] A spinal headache occurs when fluid that cushions the brain and spinal cord leaks out of the surrounding tissues. The loss of fluid leads to lower pressure in the skull, which causes the brain to sag. The tissues and nerves around the brain stretch, resulting in a headache. […] Most often, these leaks are caused by the small hole created during a spinal tap procedure. Spinal headaches can also be caused by injuries or trauma. If the cause of the leak is unknown, your child may need an MRI to diagnose a spinal headache.

• #18 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  A spinal headache is triggered when fluid leaks from your spine. The leakage decreases the fluid pressure around your brain, causing it to sag downward. When the brain sags, it stretches the surrounding nerves, creating intense head pain. […] When cerebrospinal fluid leaks from the meninges, your brain tissues and nerves stretch due to the decrease in fluid pressure in which the brain floats. An intense head pain follows this CSF leak. This is a spinal headache. […] Most spinal headaches are caused by a spinal tap. A spinal tap is when a doctor or anesthesiologist inserts analgesics through a spinal needle into the spinal canal in the lower back. […] Sometimes, the needle can leave a puncture site where spinal fluid leaks out of the epidural space. […] Epidural anesthetic is supposed to be injected on the outside of the membrane surrounding the spinal cord, but occasionally the membrane is punctured by mistake.

• #19 Spinal headache: Symptoms, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/spinal-headache

  A spinal headache occurs when cerebrospinal fluid (CSF) leaks through a puncture in the membrane that surrounds the spinal cord. This leak decreases the physical support that CSF provides for the brain, causing a headache to occur. […] Spinal headaches occur when CSF leaks from the spinal cord, and it can occur due to a puncture during a medical procedure, or as a result of trauma or disease. This leak causes the support that the CSF provides around the brain to decrease. […] A CSF leak can occur as a side effect of certain medical procedures, such as a lumbar puncture, myelogram, subarachnoid block, the administration of epidural anesthesia, or a traumatic injury. […] The main symptom of a spinal headache is a bilateral frontal or occipital headache. Other symptoms may include nausea, neck pain, dizziness, visual changes, and numbness or a tingling sensation in the arms. Spinal headache symptoms often become worse when a person stands upright. […] A doctor may treat more serious spinal headaches with an epidural blood patch.

• #20 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #21 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #22 Post-Spinal Headache: A New Possible Pathophysiology

  https://brieflands.com/articles/aapm-13562

  Postdural puncture headache (PDPH) remains a major concern after spinal anesthesia and is known to complicate 0.5% – 24% of cases. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid (CSF). A decline in CSF pressure leads to traction on pain-sensitive parietal dura and intracranial structures, thereby causing subsequent headache in patients. […] We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981.

• #23 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  The 30% – 60% efficacy of blood patch technique, as the gold standard for the treatment of PDPH, confirms the theory of CSF leakage, while some other documented treatments for PDPH suggest other pathophysiological explanations for PDPH. We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981. […] In addition, impaired cerebral autoregulation seems to play a significant role. The brain is able to maintain constant intracranial pressure through its autoregulatory mechanisms when an alteration in blood flow occurs. The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. This mechanism has been also suggested for explaining postictal agitation and headaches, associated with electroconvulsive treatments. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #24 Post-Spinal Headache: A New Possible Pathophysiology

  https://brieflands.com/articles/aapm-13562

  The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #25 The pathophysiology of lumbar puncture headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11701146/

  The pathophysiology of lumbar puncture headache (LPH) is still unclear. There is evidence that leakage of cerebrospinal fluid (CSF) leads to CSF hypotension, which causes dilation of intracranial veins, resulting in LPH. […] We propose the hypothesis that LPH is caused by an abnormal distribution of craniospinal elasticity. Increased compliance at the lumbar end of the spinal CSF space, resulting both from anatomic joining of the subarachnoid to the epidural space and from reduced CSF filling pressure, causes the hydrostatic indifferent point to move caudally, creating additional intracranial hypotension and venous dilation in the erect position. […] The near absence of LPH in the very young and in the elderly relates to the relative stiffness of the epidural space at these ages. Epidural injections of blood or saline give immediate relief by reducing epidural distensibility.

• #26 The pathophysiology of lumbar puncture headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11701146/

  The pathophysiology of lumbar puncture headache (LPH) is still unclear. There is evidence that leakage of cerebrospinal fluid (CSF) leads to CSF hypotension, which causes dilation of intracranial veins, resulting in LPH. […] We propose the hypothesis that LPH is caused by an abnormal distribution of craniospinal elasticity. Increased compliance at the lumbar end of the spinal CSF space, resulting both from anatomic joining of the subarachnoid to the epidural space and from reduced CSF filling pressure, causes the hydrostatic indifferent point to move caudally, creating additional intracranial hypotension and venous dilation in the erect position. […] The near absence of LPH in the very young and in the elderly relates to the relative stiffness of the epidural space at these ages. Epidural injections of blood or saline give immediate relief by reducing epidural distensibility.

• #27 What Is Spinal Headache?

  https://www.icliniq.com/articles/neurological-health/spinal-headache

  Spinal headache is the most commonly arising complication following procedures such as lumbar punctures (spinal tap) or spinal anesthesia. […] The precise pathophysiology of post-lumbar puncture headaches remains uncertain. However, it is likely associated with the formation of a hole in the dura mater (thick outer membrane of skull and vertebra) upon needle withdrawal, leading to an ongoing cerebrospinal fluid leak from the subarachnoid space. This continuous leakage results in a reduction of intracranial CSF volume and pressure. While there is agreement existing on the loss of CSF and the subsequent decrease in CSF pressure, the specific mechanism triggering post-lumbar puncture headaches is not well-defined. Two potential explanations are considered: […] Firstly, the diminished CSF volume may deplete the fluid cushion, supporting the brain and its sensitive meningeal vascular coverings. This, in turn, causes gravitational traction on the pain-sensitive intracranial structures, resulting in a classical headache that worsens in an upright position and is alleviated when lying down. […] Secondly, the reduction in CSF volume might directly activate adenosine receptors, leading to cerebral vasodilation (widening of blood vessels) and stretching of pain-sensitive cerebral structures, ultimately causing headaches after lumbar puncture.

• #28 Post Lumbar Puncture Headaches – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/post-lumbar-puncture-headaches/

  There are two mechanisms which we believe are the cause of post LP headaches: […] Lumbar PunctureLPs are a traumatic procedure, in which a needle is inserted through the dura to access the dural space. After the needle is withdrawn from the dural space, there can be a persistent hole in the dura. If this hole is large enough, CSF fluid can leak out and cause a drop in CSF pressure. It is believed that this drop in pressure decreases the fluid supporting the brain causing traction on the brain which cause the resultant headache. […] It is also theorized that a drop in CSF volume will cause a direct activation of adenosine receptors. This activation leads to cerebral vasculature vasodilatation which can cause cerebral stretching and result in headaches.

• #29 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #30 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #31 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #32 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #33 Spinal Headaches, Lumbar Puncture Headache, Prevention and Treatment – Emergency Care Services | No Wait Open 24 HRS

  https://postoaker.com/how-are-lumbar-puncture-headaches-prevented-and-treated/

  Other conditions resulting in the spinal fluid leak include a head injury (fractured skull) or a ruptured cyst. […] Mild cases of spinal headaches resolve on their own without treatment; however, if your headache persists for more than a few days, you should see a physician. […] Your doctor may use an epidural blood patch to seal up the hole. An epidural patch is created using a needle to take a small amount of blood from your skin and inject it into the epidural space. The blood forms a clot and seals the site of leakage. […] Specific factors that can increase the risk of lumbar puncture headache include: Age ( young adult between the age of 18 and 30), Pregnancy, Previous history of a severe headache, A small body mass. […] Your doctor can minimize the risk of causing a post-lumbar puncture headache by using a non-cutting needle for the procedure. […] The complications of lumbar puncture include introducing infection into the meninges, severe headache, and sudden coning of the brain stem.

• #34 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Several factors contribute to the development of headache after lumbar puncture, including needle size, needle design, direction of the bevel, and number of LP attempts. […] Modifiable risk factors of PDPH include needle size, needle shape, bevel orientation and insertion angle, stylet replacement, and operator experience. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. […] The smaller needle diameter reduces the incidence of PDPH. […] However, multiple dural punctures caused by unsuccessful puncture would increase the rate of PDPH. […] Needle design variables, such as the needle size and needle shape, have been modified to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF.

• #35 5 Options for Spinal Headache Treatment | SSOR

  https://ssorkc.com/5-options-for-spinal-headache-treatment/

  A spinal headache can develop after a lumbar puncture or spinal tap. A lumbar puncture is a medical procedure where a needle is inserted into the spinal canal to collect cerebrospinal fluid. This headache occurs when cerebrospinal fluid leaks through the puncture site. The leaking fluid causes pressure to drop in the spinal canal and causes headache and other symptoms. […] A spinal headache can be a rare side effect of epidural anesthesia. Epidural anesthesia is commonly used during childbirth and can also be used for other medical procedures. […] The size of the needle can play a direct factor in developing a spinal headache. If a larger needle is used, the chances of cerebrospinal fluid leaking increases. A larger needle used in the procedure can come with a chance of up to 70% of developing a spinal headache. If a smaller needle is used, the chance can be 12% of developing a spinal headache.

• #36 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Several factors contribute to the development of headache after lumbar puncture, including needle size, needle design, direction of the bevel, and number of LP attempts. […] Modifiable risk factors of PDPH include needle size, needle shape, bevel orientation and insertion angle, stylet replacement, and operator experience. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. […] The smaller needle diameter reduces the incidence of PDPH. […] However, multiple dural punctures caused by unsuccessful puncture would increase the rate of PDPH. […] Needle design variables, such as the needle size and needle shape, have been modified to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF.

• #37 5 Options for Spinal Headache Treatment | SSOR

  https://ssorkc.com/5-options-for-spinal-headache-treatment/

  The kind of needle can also play a factor in the risk of developing a spinal headache. If an atraumatic needle that has a diamond-shaped tip is used for the procedure, you have a lower chance of developing a headache. […] The number of attempts directly relates to the amount of damage in the spinal canal. If a larger needle or multiple attempts are required, the damage to the spinal canal will leave a more significant chance of spinal fluid leaking into the canal, which can lead to the development of a headache.

• #38 Incidence and risk factors of postdural puncture headache: prospective cohort study design | Perioperative Medicine | Full Text

  https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00164-2

  Several factors contribute to the development of headache after lumbar puncture, including needle size, needle design, direction of the bevel, and number of LP attempts. […] Modifiable risk factors of PDPH include needle size, needle shape, bevel orientation and insertion angle, stylet replacement, and operator experience. […] Needle size might be the most significant factor in the development of PDPH. […] The incidence of PDPH after spinal anesthesia performed with Quincke, cutting needle, is 36% with 22-G needle, 25% with 25-G needle, 2 to 12% with 26-G needle, and less than 2% for smaller than 26-G needles. […] The smaller needle diameter reduces the incidence of PDPH. […] However, multiple dural punctures caused by unsuccessful puncture would increase the rate of PDPH. […] Needle design variables, such as the needle size and needle shape, have been modified to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF.

• #39 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #40 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #41 Spinal Headache: Symptoms, Causes, Complications and Treatment

  https://www.carehospitals.com/indore/diseases-conditions/spinal-headache

  Doctors can significantly reduce the risk of spinal headaches by using specialised equipment during procedures. The key preventive tool is a non-cutting needle or atraumatic needle, which creates a smaller puncture in the spinal membrane, reducing the likelihood of cerebrospinal fluid leakage. […] Spinal headaches present unique challenges that set them apart from regular headaches. Their distinctive positional nature – pain that worsens when sitting or standing – makes them easier to identify, though proper medical evaluation remains essential for accurate diagnosis.

• #42 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  The 30% – 60% efficacy of blood patch technique, as the gold standard for the treatment of PDPH, confirms the theory of CSF leakage, while some other documented treatments for PDPH suggest other pathophysiological explanations for PDPH. We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981. […] In addition, impaired cerebral autoregulation seems to play a significant role. The brain is able to maintain constant intracranial pressure through its autoregulatory mechanisms when an alteration in blood flow occurs. The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. This mechanism has been also suggested for explaining postictal agitation and headaches, associated with electroconvulsive treatments. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #43 Spinal Headaches from Epidural or Lumbar Puncture

  https://www.webmd.com/migraines-headaches/pain-management-spinal-headaches

  A spinal headache is the name for a type of headache that follows a procedure like a spinal tap (lumbar puncture) or epidural block (such as that performed during labor and delivery). […] This creates a passage for the spinal fluid to leak out, which changes the fluid pressure around your brain and spinal cord. If enough of the fluid leaks out, you may get a spinal headache. […] Because the design of spinal needles has improved, spinal headaches after you get a spinal tap or spinal anesthesia are rare. The odds are usually low after an epidural, too, unless the needle accidentally punctures the dura mater, a tough membrane that covers your spinal cord. […] If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. To put the blood patch in place, the anesthesiologist will put a needle into the same space as, or right next to, the area where the anesthetic was injected. Next, theyll take a small amount of your blood and inject it into the epidural space. The blood clots and seals the hole that caused the leak.

• #44 Postdural Puncture Headache – NYSORA

  https://www.nysora.com/topics/complications/postdural-puncture-headache/

  The patient characteristic having the greatest impact on risk of PDPH is age. […] Needle size and tip design are the most important procedural factors related to PDPH. […] The EBP, a startlingly unique medical procedure, proved to be the major breakthrough in the treatment of PDPH. […] The mechanism of action of the EBP, while not entirely elucidated, appears to be related to the ability to stop further CSF loss by the formation of clot over the defect in the meninges as well as a tamponade effect with cephalad displacement of CSF. […] The EBP should be encouraged in patients experiencing ADP with an epidural needle and those whose symptoms are categorized as severe (ie, pain score > 6 on a 1–10 scale).

• #45 Spinal Headache – Obstetrical Anesthesia Associates

  https://obepidural.com/patient-education/spinal-headache/

  The gold-standard for treating a spinal headache is a procedure called an epidural blood patch. During an epidural blood patch, we draw blood from you in a sterile manner and inject it into your epidural space. […] An epidural blood patch seems to work in a couple of ways. […] One of the jobs of your blood in your body is to find broken places and try to heal them. The first step in this is that little platelets in your blood stick together at the edges of damaged tissue. Your blood will do the same thing to the hole in your spinal sac and essentially form a cork that will plug the hole and the leak. […] If you only get partial relief of your headache at first, over 12-24 hours your balloon will fill up with fluid again and the headache will go away.

• #46 Epidural Blood Patch for Spinal Headaches Relieving the Pain – Columbia Pain Management, P.C.

  https://columbiapain.org/epidural-blood-patch-for-spinal-headaches-relieving-the-pain/

  Headaches can be incredibly debilitating, and when leakage of spinal fluid causes them, they are known as spinal headaches. […] An epidural blood patch is a surgical procedure that involves injecting blood into the epidural space of the spinal area. This injection closes the opening through which the spinal fluid leaks, providing fast and effective relief from headaches. […] An epidural blood patch is typically offered to patients who experience spinal headaches after procedures such as a lumbar puncture. […] The injected blood clots increase pressure in the area and effectively seal the hole, preventing further fluid leakage and relieving the headache. […] However, in many cases, spinal headaches have been effectively resolved following an epidural blood patch.

• #47 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  Upper cervical chiropractic care is effective at normalizing cerebrospinal fluid pressure. A lot of research supports chiropractic care’s ability to treat headaches. […] Chiropractic alignment also reduces the physical stress that can lead to headaches. […] Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] In rare situations, if your spinal headache goes untreated, it can trigger complications, sometimes life-threatening: bleeding in your skull (called subdural hematoma), bleeding in your back, infection, and seizure. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #48 Headache: What It Is, Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9639-headaches

  Spinal headaches: Spinal headaches are intense headaches that occur when spinal fluid leaks out of the membrane covering your spinal cord, usually after a spinal tap. Most spinal headaches can be treated at home, but prolonged, untreated spinal headaches can cause life-threatening complications, including subdural hematoma and seizures. […] Headache pain results from signals interacting among your brain, blood vessels and surrounding nerves. During a headache, multiple mechanisms activate specific nerves that affect muscles and blood vessels. These nerves send pain signals to your brain, causing a headache.

• #49 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  Upper cervical chiropractic care is effective at normalizing cerebrospinal fluid pressure. A lot of research supports chiropractic care’s ability to treat headaches. […] Chiropractic alignment also reduces the physical stress that can lead to headaches. […] Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] In rare situations, if your spinal headache goes untreated, it can trigger complications, sometimes life-threatening: bleeding in your skull (called subdural hematoma), bleeding in your back, infection, and seizure. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #50 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  Upper cervical chiropractic care is effective at normalizing cerebrospinal fluid pressure. A lot of research supports chiropractic care’s ability to treat headaches. […] Chiropractic alignment also reduces the physical stress that can lead to headaches. […] Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] In rare situations, if your spinal headache goes untreated, it can trigger complications, sometimes life-threatening: bleeding in your skull (called subdural hematoma), bleeding in your back, infection, and seizure. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #51 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  Upper cervical chiropractic care is effective at normalizing cerebrospinal fluid pressure. A lot of research supports chiropractic care’s ability to treat headaches. […] Chiropractic alignment also reduces the physical stress that can lead to headaches. […] Studies show that visiting a high-quality chiropractor can reduce the frequency, duration, and intensity of headaches as well as your reliance on pharmaceuticals. […] In rare situations, if your spinal headache goes untreated, it can trigger complications, sometimes life-threatening: bleeding in your skull (called subdural hematoma), bleeding in your back, infection, and seizure. […] Chiropractic care may help to regulate cerebrospinal fluid levels and prevent headache symptoms.

• #52 Headache: What It Is, Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9639-headaches

  Spinal headaches: Spinal headaches are intense headaches that occur when spinal fluid leaks out of the membrane covering your spinal cord, usually after a spinal tap. Most spinal headaches can be treated at home, but prolonged, untreated spinal headaches can cause life-threatening complications, including subdural hematoma and seizures. […] Headache pain results from signals interacting among your brain, blood vessels and surrounding nerves. During a headache, multiple mechanisms activate specific nerves that affect muscles and blood vessels. These nerves send pain signals to your brain, causing a headache.

• #53 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  Headache usually resolves within a few days, but the longest reported headache after lumbar puncture lasted for 19 months. […] Unintended dural puncture is associated with an increased risk of longer-term or persistent headaches. […] The patient with inadvertent dural puncture may have chronic headache, backache, neck ache, depression, cranial nerve palsy, subdural hematoma or cerebral venous thrombosis. […] Evidence to determine whether EBP mitigates, prevents or treats these sequelae is inadequate.

• #54 Post-epidural headaches can be more serious than previously known – Scope

  https://scopeblog.stanford.edu/2021/08/02/post-epidural-headaches-can-be-more-serious-than-previously-known/

  In about 1% of cases, the needle advances deeper than intended and punctures the spinal membrane and causes a large leak of spinal fluid, which can cause headaches, said Ansari, clinical assistant professor of anesthesiology. […] It’s not clear what causes the headaches, but during the past 10 years there has been a growing body of evidence showing that they may be more serious and persistent than previously thought, Flood said. […] We have confirmed in this well-powered prospective study that women who had unintentional dural punctures from an epidural needle have double the risk for chronic headaches compared to new moms who did not have this complication, Flood said. […] Ansari said the study findings mean that these women should be carefully followed to support them and further investigate ways to treat spinal headaches.

• #55 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  Headache usually resolves within a few days, but the longest reported headache after lumbar puncture lasted for 19 months. […] Unintended dural puncture is associated with an increased risk of longer-term or persistent headaches. […] The patient with inadvertent dural puncture may have chronic headache, backache, neck ache, depression, cranial nerve palsy, subdural hematoma or cerebral venous thrombosis. […] Evidence to determine whether EBP mitigates, prevents or treats these sequelae is inadequate.

• #56 Statement on Post-Dural Puncture Headache Management | American Society of Anesthesiologists (ASA)

  https://www.asahq.org/standards-and-practice-parameters/statement-on-post-dural-puncture-headache-management

  PDPH Pathophysiology Low intracranial CSF volume or intracranial hypotension may develop due to an intentional (spinal anesthesia) or unintended dural puncture (UDP) causing a loss of CSF into the epidural space through the dural hole leading to a fall in CSF pressure. The headache is postulated to be caused by traction on pain sensitive structures in the cranium; another etiology may be due to increased cerebral blood flow in response to decreased intracranial cerebral spinal fluid. The proposed mechanism regarding the formation of an intracranial subdural hematoma after UDP is from decreased intracranial pressure placing traction on the bridging veins between the dura and arachnoid, resulting in their tearing and subsequent hematoma formation. […] Emerging data from 5 retrospective and 3 prospective studies support an association between PDPH, especially after unintentional dural puncture with an epidural needle, with chronic headache sequelae.

• #57 Intracranial hypotension syndrome: A post dural puncture headache?

  http://www.scielo.org.co/scielo.php?pid=S0120-33472013000100010&script=sci_arttext&tlng=en

  This may cause rupture of the cerebral veins, creating subdural hematomas, as was the case with our second patient. […] Dural post-puncture headache may be considered a mild form of IHS in which orthostatic headache is the predominant symptom. […] This and other signs and symptoms are part of IHS. […] However, the boundary between the definition of post-puncture headache and the degree of severity leading to the categorization of this entity as IHS is blurred, creating a discussion where there are still many questions to be answered. […] In conclusion, IHS is an infrequent occurrence, probably underdiagnosed, which complicates the clinical condition in some patients undergoing conductive neuroaxial anesthesia.

• #58 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #59 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #60 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #61 Spinal Headache: Causes, Prevention, Treatment & Complications

  https://www.denveruppercervical.com/spinal-headache

  When a doctor performs a spinal tap, they can prevent spinal headaches by opting for a smaller, blunt-tipped spinal needle called a non-cutting needle or atraumatic needle. […] A non-cutting needle reduces the risk of leakage and, therefore, the risk of spinal headaches. […] Other causes of spinal headaches include a ruptured cyst on the spinal cord and head/face/skull trauma. Either of these may cause spinal fluid to leak, resulting in low CSF pressure around the brain (intracranial hypotension). […] The risk factors for spinal headaches include: spinal tap procedure in the last two weeks, recent head injury, pregnancy, low BMI (body mass index), age 18 to 30 years old, and female (women are more likely to get a spinal headache). […] Spinal headaches are not usually dangerous. Often, the body self-heals the puncture hole in the dura mater surrounding the spinal cord, allowing fluid pressure to be restored.

• #62 Spinal Headaches, Lumbar Puncture Headache, Prevention and Treatment – Emergency Care Services | No Wait Open 24 HRS

  https://postoaker.com/how-are-lumbar-puncture-headaches-prevented-and-treated/

  Other conditions resulting in the spinal fluid leak include a head injury (fractured skull) or a ruptured cyst. […] Mild cases of spinal headaches resolve on their own without treatment; however, if your headache persists for more than a few days, you should see a physician. […] Your doctor may use an epidural blood patch to seal up the hole. An epidural patch is created using a needle to take a small amount of blood from your skin and inject it into the epidural space. The blood forms a clot and seals the site of leakage. […] Specific factors that can increase the risk of lumbar puncture headache include: Age ( young adult between the age of 18 and 30), Pregnancy, Previous history of a severe headache, A small body mass. […] Your doctor can minimize the risk of causing a post-lumbar puncture headache by using a non-cutting needle for the procedure. […] The complications of lumbar puncture include introducing infection into the meninges, severe headache, and sudden coning of the brain stem.

• #63 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #64 Spinal Headaches: Symptoms, Causes, and Treatment

  https://resources.healthgrades.com/right-care/migraine-and-headache/spinal-headache

  A spinal headache develops when cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks. It often occurs as a complication of a lumbar puncture, but injury and surgery can also be responsible. […] CSF leakage reduces pressure around the brain, causing pain by: […] causing traction on sensitive structures such as the blood vessels and nerves […] slight sagging of the brain […] dilation and inflammation of blood vessels, glands, and other structures in the head. […] Spinal headaches are caused by CSF leaking from the spinal cord. This happens as a result of puncturing the spinal dura — a tube-like membrane that surrounds the spinal cord. […] Sometimes CSF leaks happen spontaneously, or without an obvious cause. Researchers are still investigating why spontaneous CSF leaks happen, but they may be linked to having a weak dura. […] In some cases, you may need treatment to resolve the underlying cause of the spinal headache, such as: […] Surgical procedures for CSF leaks include repairing a dural tear, strengthening the dura, or tying off meningeal diverticula.

• #65 High and Low Pressure Headache: Symptoms, Causes, and Emergency Signs

  https://headacheaustralia.org.au/high-and-low-pressure-headache/

  Another less common cause are people who develop a spontaneous leak, usually from a tear in the meninges in the spinal column. This type of headache can be very sudden in onset, but can also be a gradual onset. These spontaneous leaks still have the orthostatic (pain severity changes with body posture) component to it. […] Interestingly, about two thirds of people who have this particular type of problem have abnormal connective tissue. […] Management is conservative with bed rest and fluids in the first instance, particularly after a recent lumbar puncture. […] A blood patch is something that is used fairly often. This is where a sample of blood is taken and injected into the spine where the tear is, to seal the hole. […] In terms of causes for high-pressure headaches, there can be too much CSF, which is called hydrocephalus.

• #66

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/spinal-headaches

  Spinal headaches are a fairly common complication in those who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the membrane that surrounds the spinal cord and, in the lower spine, the lumbar and sacral nerve roots. […] If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache. […] Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) 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 48 to 72 hours after a spinal tap or spinal anesthesia. […] Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured.

• #67 Spinal headaches: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

  https://www.prepladder.com/neet-pg-study-material/anaesthesia/spinal-headaches-causes-symptoms-risk-factors-diagnosis-and-treatment

  Spinal headaches are a common side effect following spinal anaesthesia or a spinal tap (lumbar puncture). Both operations include puncturing the membrane surrounding the spinal cord and the lumbar and sacral nerve roots in the lower spine. […] The membrane (dura mater) that envelops the spinal cord can puncture, allowing spinal fluid to seep out and causing headaches. A headache results from this leaking, which lessens the pressure that the spinal fluid provides on the brain and spinal cord. […] The majority of the time, 48 to 72 hours following a spinal tap or spinal anaesthesia, spinal headaches develop. […] An additional side effect of epidural anaesthesia is occasionally a spinal headache. A spinal headache could result from an accidental puncture of the membrane enclosing the spinal cord, even when the epidural anaesthetic is given just outside of it.

• #68 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #69 Headache When Sitting or Standing – Spinal Headaches | NHI

  https://nationalheadacheinstitute.com/blog/spinal-headaches/

  Spinal headaches tend to be worse when you are sitting or standing up and improve immediately when lying down. […] A spinal headache can often occur after certain procedures such as a lumbar puncture, a spinal tap or an epidural block. In fact, over 40% of patients receiving these procedures report a spinal headache immediately afterwards. In most cases, these headaches disappear within 24 hours. […] During these procedures, a thin needle is used to create a passage to the spine and this is when spinal fluid can leak. The change in fluid pressure around the spinal cord and brain can cause a spinal headache to occur. […] The pain that is caused by a spinal headache can actually last for up to 5 days and sometimes more. The first thing to do when treating a spinal headache is to try to regulate the pressure within the spinal cord. Sometimes the patient will be told to drink beverages that are high in caffeine or on other occasions fluids will be administered through an intravenous drip. The patient may also be placed on strict bed rest for up to 48 hours.

• #70 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #71

  https://continentalhospitals.com/diseases/spinal-headaches/

  Additionally, individuals experiencing spinal headaches may also encounter sensitivity to light and sound, as well as nausea and vomiting. […] One common diagnostic tool used for spinal headaches is a thorough medical history assessment. […] In addition to a comprehensive medical history, physical examinations play a vital role in diagnosing spinal headaches. […] These examinations help doctors rule out other potential causes of headaches and narrow down on a diagnosis. […] One common approach to treating spinal headaches is through conservative measures. […] In more severe cases or when conservative measures fail to alleviate symptoms, medical interventions may be necessary. […] One such intervention is a blood patch procedure. […] This procedure involves injecting a small amount of the patient’s own blood into the epidural space near the site of the spinal leak.

• #72 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  This definition helps to avoid confusion with migraine or headache after lumbar puncture. […] Even though the onset of PSH is usually within 24-48 hours after dural puncture, it could be delayed by up to 12 days or months. […] This is essentially a clinical diagnosis. […] The history of spinal anesthesia, combined spinal epidural anesthesia or epidural block and the postural nature of the headache with associated symptoms usually confirms the diagnosis. […] PSH is usually dull or throbbing and initially in the frontal or occipital region, which can be generalized as it progresses. […] Pain is exacerbated by head movements, coughing, sneezing, straining or ocular compression. […] Other associated symptoms are seen in 70% of patients along with headache. […] The patient may have neck stiffness, pain in the cervical, thoracic or lumbar vertebral region, nausea, vomiting, vertigo, tinnitus and rarely, diplopia due to cranial nerve palsy, blurred vision and auditory disturbances.

• #73 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  This definition helps to avoid confusion with migraine or headache after lumbar puncture. […] Even though the onset of PSH is usually within 24-48 hours after dural puncture, it could be delayed by up to 12 days or months. […] This is essentially a clinical diagnosis. […] The history of spinal anesthesia, combined spinal epidural anesthesia or epidural block and the postural nature of the headache with associated symptoms usually confirms the diagnosis. […] PSH is usually dull or throbbing and initially in the frontal or occipital region, which can be generalized as it progresses. […] Pain is exacerbated by head movements, coughing, sneezing, straining or ocular compression. […] Other associated symptoms are seen in 70% of patients along with headache. […] The patient may have neck stiffness, pain in the cervical, thoracic or lumbar vertebral region, nausea, vomiting, vertigo, tinnitus and rarely, diplopia due to cranial nerve palsy, blurred vision and auditory disturbances.

• #74 Beware while Treating Post-Spinal Headache!

  https://www.longdom.org/open-access/beware-while-treating-postspinal-headache-106330.html

  This definition helps to avoid confusion with migraine or headache after lumbar puncture. […] Even though the onset of PSH is usually within 24-48 hours after dural puncture, it could be delayed by up to 12 days or months. […] This is essentially a clinical diagnosis. […] The history of spinal anesthesia, combined spinal epidural anesthesia or epidural block and the postural nature of the headache with associated symptoms usually confirms the diagnosis. […] PSH is usually dull or throbbing and initially in the frontal or occipital region, which can be generalized as it progresses. […] Pain is exacerbated by head movements, coughing, sneezing, straining or ocular compression. […] Other associated symptoms are seen in 70% of patients along with headache. […] The patient may have neck stiffness, pain in the cervical, thoracic or lumbar vertebral region, nausea, vomiting, vertigo, tinnitus and rarely, diplopia due to cranial nerve palsy, blurred vision and auditory disturbances.

• #75 That Chronic Headache Could Be the Result of a Back or Neck Injury: Hui Kang, MD: Pain Management

  https://www.houstonpainspecialists.com/blog/that-chronic-headache-could-be-the-result-of-a-back-or-neck-injury

  Back and neck injuries are normally associated with headaches; patients often report that they experience headaches even after recovering from a back injury. […] If a headache is caused by a spinal injury, its known as a cervicogenic headache. […] Unlike a migraine, a cervicogenic headache doesnt originate in the brain. These headaches start in a different part of your body, usually the neck or back. […] Whiplash, for example, is damage to the tendons and muscles in your neck. […] Back injuries are known to affect other parts of the body. Spinal stenosis is a condition that narrows the small foramina, the little openings of the vertebrae. […] A pinched neck nerve, or cervical radiculopathy, can cause intense headaches. […] Osteoarthritis is a degenerative joint disease. It causes the joint cartilage to wear down and puts a lot of pressure on your spinal nerves. […] Spinal osteoarthritis can cause bone spurs as the cartilage breaks down in the discs that separate your vertebrae. Bone spurs can irritate the cervical nerves. The irritation can produce headaches and pain in your neck.

• #76 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #77 Post dural puncture headache – UpToDate

  https://www.uptodate.com/contents/post-dural-puncture-headache

  Post dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is a common complication of diagnostic LP. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. The headache is usually positional (worse when upright, better when lying flat) and is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. […] The precise etiology of headache after dural puncture is unclear, but is thought to relate to leakage of cerebrospinal fluid (CSF) through the dural hole created by the needle. If CSF leaks at a rate greater than the rate of CSF production, low CSF pressure can result, accentuated at the level of the brain in the upright position. However, not all patients with PDPH have low CSF pressure, and not all patients with significant CSF leak develop a headache.

• #78 Post-Spinal Headache: A New Possible Pathophysiology

  https://brieflands.com/articles/aapm-13562

  The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #79 Post-lumbar puncture headache | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2012/04/post-lumbar-puncture-headache

  Post-dural puncture headache (PDPH) is characterised by the occurrence of a headache with a definite orthostatic component within five days of a lumbar puncture. […] The underlying mechanisms are undoubtedly more complex. According to the Monro-Kellie-Burrows doctrine (the sum of the volumes of the cerebrospinal fluid, the blood and the brain tissue in the skull remain constant), loss of cerebrospinal fluid may result in compensatory intracranial vasodilation. […] The risk factors for headache after spinal puncture can be classified as non-modifiable or modifiable. […] The calibre of the needle is directly associated with the incidence of post-dural puncture headache. […] Using an atraumatic needle can also substantially reduce the incidence of post-dural puncture headache. […] The incidence of these headaches can be reduced by using thin atraumatic needles in the procedure.

• #80 Spinal Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches

  Spinal headaches happen when cerebrospinal fluid around your brain decreases, usually due to a spinal tap or meningeal tear. […] Leakage of cerebrospinal fluid can cause the tissues and nerves that support your brain to stretch, resulting in headache pain. […] The most common cause of a spinal headache is a puncture (hole) created during a spinal tap or lumbar puncture. […] The loss of fluid results in low CSF pressure around your brain (intracranial hypotension). This causes your brain to sag downward. The surrounding nerves and tissues become stretched, which results in a headache. […] Other conditions can cause spinal fluid leaks that lead to spinal headaches, including a ruptured (burst) cyst on your spinal cord, a tear in the meninges of your spinal cord, or a head or face injury, such as a fractured skull. […] Healthcare providers can reduce the risk of a spinal headache developing by performing a spinal tap using a small needle called a non-cutting needle.

• #81 Spinal Headaches | Arkansas Children’s

  https://www.archildrens.org/programs-and-services/neuroscience-center/headache-program/Conditions/spinal-headache

  A spinal headache is a severe headache caused by a cerebrospinal fluid leak, the fluid surrounding the brain and spinal cord. The loss of fluid leads to lower pressure in the skull, which causes the brain to sag. The tissues and nerves around the brain stretch, resulting in a headache. […] A spinal headache occurs when fluid that cushions the brain and spinal cord leaks out of the surrounding tissues. The loss of fluid leads to lower pressure in the skull, which causes the brain to sag. The tissues and nerves around the brain stretch, resulting in a headache. […] Most often, these leaks are caused by the small hole created during a spinal tap procedure. Spinal headaches can also be caused by injuries or trauma. If the cause of the leak is unknown, your child may need an MRI to diagnose a spinal headache.

• #82 Post-Spinal Headache: A New Possible Pathophysiology

  https://brieflands.com/articles/aapm-13562

  Postdural puncture headache (PDPH) remains a major concern after spinal anesthesia and is known to complicate 0.5% – 24% of cases. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid (CSF). A decline in CSF pressure leads to traction on pain-sensitive parietal dura and intracranial structures, thereby causing subsequent headache in patients. […] We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981.

• #83 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  The 30% – 60% efficacy of blood patch technique, as the gold standard for the treatment of PDPH, confirms the theory of CSF leakage, while some other documented treatments for PDPH suggest other pathophysiological explanations for PDPH. We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981. […] In addition, impaired cerebral autoregulation seems to play a significant role. The brain is able to maintain constant intracranial pressure through its autoregulatory mechanisms when an alteration in blood flow occurs. The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. This mechanism has been also suggested for explaining postictal agitation and headaches, associated with electroconvulsive treatments. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #84 The pathophysiology of lumbar puncture headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11701146/

  The pathophysiology of lumbar puncture headache (LPH) is still unclear. There is evidence that leakage of cerebrospinal fluid (CSF) leads to CSF hypotension, which causes dilation of intracranial veins, resulting in LPH. […] We propose the hypothesis that LPH is caused by an abnormal distribution of craniospinal elasticity. Increased compliance at the lumbar end of the spinal CSF space, resulting both from anatomic joining of the subarachnoid to the epidural space and from reduced CSF filling pressure, causes the hydrostatic indifferent point to move caudally, creating additional intracranial hypotension and venous dilation in the erect position. […] The near absence of LPH in the very young and in the elderly relates to the relative stiffness of the epidural space at these ages. Epidural injections of blood or saline give immediate relief by reducing epidural distensibility.

• #85 What Is Spinal Headache?

  https://www.icliniq.com/articles/neurological-health/spinal-headache

  Spinal headache is the most commonly arising complication following procedures such as lumbar punctures (spinal tap) or spinal anesthesia. […] The precise pathophysiology of post-lumbar puncture headaches remains uncertain. However, it is likely associated with the formation of a hole in the dura mater (thick outer membrane of skull and vertebra) upon needle withdrawal, leading to an ongoing cerebrospinal fluid leak from the subarachnoid space. This continuous leakage results in a reduction of intracranial CSF volume and pressure. While there is agreement existing on the loss of CSF and the subsequent decrease in CSF pressure, the specific mechanism triggering post-lumbar puncture headaches is not well-defined. Two potential explanations are considered: […] Firstly, the diminished CSF volume may deplete the fluid cushion, supporting the brain and its sensitive meningeal vascular coverings. This, in turn, causes gravitational traction on the pain-sensitive intracranial structures, resulting in a classical headache that worsens in an upright position and is alleviated when lying down. […] Secondly, the reduction in CSF volume might directly activate adenosine receptors, leading to cerebral vasodilation (widening of blood vessels) and stretching of pain-sensitive cerebral structures, ultimately causing headaches after lumbar puncture.

• #86 Post Lumbar Puncture Headaches – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/post-lumbar-puncture-headaches/

  There are two mechanisms which we believe are the cause of post LP headaches: […] Lumbar PunctureLPs are a traumatic procedure, in which a needle is inserted through the dura to access the dural space. After the needle is withdrawn from the dural space, there can be a persistent hole in the dura. If this hole is large enough, CSF fluid can leak out and cause a drop in CSF pressure. It is believed that this drop in pressure decreases the fluid supporting the brain causing traction on the brain which cause the resultant headache. […] It is also theorized that a drop in CSF volume will cause a direct activation of adenosine receptors. This activation leads to cerebral vasculature vasodilatation which can cause cerebral stretching and result in headaches.

• #87

  https://link.springer.com/article/10.1007/s10072-020-04757-z

  This manuscript is a narrative review of peer-reviewed studies of postdural puncture headache (PDPH) as the most common complication of a diagnostic and therapeutic lumbar puncture (LP) and LP due to the damage of the dura mater in epidural anesthesia. […] The analysis of prediction parameters for the onset, clinical course, and associated symptoms and signs of PDPH is a contribution to the understanding of pathophysiology of intracranial hypotension, since PDPH can be considered a clinical model of intracranial hypotension. […] Given that LP is a common procedure in clinical practice, it is necessary to have a comprehensive knowledge of the risk factors, pathophysiological, diagnostic, differentially diagnostic, and therapeutic aspects of PDPH.

• #88 Post-Spinal Headache: A New Possible Pathophysiology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5554423/

  The 30% – 60% efficacy of blood patch technique, as the gold standard for the treatment of PDPH, confirms the theory of CSF leakage, while some other documented treatments for PDPH suggest other pathophysiological explanations for PDPH. We postulate that brain hyperperfusion due to the sudden increase in cerebral blood flow (CBF) after sudden global vasodilation in spinal anesthesia might be one of the underlying mechanisms of PDPH. Hyperperfusion syndrome, a clinical syndrome presenting as a migrainous phenomenon, transient focal seizure activity, or intracerebral hemorrhage following carotid endarterectomy, was initially described by Sundt in 1981. […] In addition, impaired cerebral autoregulation seems to play a significant role. The brain is able to maintain constant intracranial pressure through its autoregulatory mechanisms when an alteration in blood flow occurs. The low-flow state, induced by hypotension after spinal anesthesia, can result in the compensatory dilation of cerebral vessels to maintain adequate CBF. This dilation might cause the vessels to lose their ability to autoregulate vascular resistance in response to the sudden increase in blood pressure. As a consequence, CBF increases after the rise in blood pressure, which can cause headaches, similar to what occurs in hyperperfusion syndrome. This mechanism has been also suggested for explaining postictal agitation and headaches, associated with electroconvulsive treatments. […] Overall, our theory reflects the Monro-Kellie doctrine, which indicates that the sum of brain volume, CSF, and intracranial blood is kept constant. CSF loss results in an increase in blood volume due to venodilatation, which might be the cause of headache.

• #89 Postdural Puncture Headache – NYSORA

  https://www.nysora.com/topics/complications/postdural-puncture-headache/

  The patient characteristic having the greatest impact on risk of PDPH is age. […] Needle size and tip design are the most important procedural factors related to PDPH. […] The EBP, a startlingly unique medical procedure, proved to be the major breakthrough in the treatment of PDPH. […] The mechanism of action of the EBP, while not entirely elucidated, appears to be related to the ability to stop further CSF loss by the formation of clot over the defect in the meninges as well as a tamponade effect with cephalad displacement of CSF. […] The EBP should be encouraged in patients experiencing ADP with an epidural needle and those whose symptoms are categorized as severe (ie, pain score > 6 on a 1–10 scale).

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