Headache after an epidural or spinal injection

• The headache can be severe
• You tend to feel it at the front or the back of your head
• It can feel worse when sitting or standing and feels better if lying down
• You might have neck pain or stiffness
• You might feel sick and develop sensitivity to light
• It usually starts between 1 day and 1 week after the anaesthetic.

The brain and spinal cord are in a bag of fluid called the ‘dura’. A dural headache happens if some of this fluid leaks out and the pressure around the spine and brain falls. This can happen after a spinal or epidural if the needle accidentally pierces this bag.
 
If you sit or stand up, the pressure in the dura can fall even further. This can make the headache feel worse. If you lie down, the pressure increases and the headache can feel better. 

If you develop a headache there are some things that you can do yourself initially:

• take over the counter pain relief such as paracetamol or ibuprofen
• drink plenty of fluids
• caffeinated drinks can help (coffee, tea, cola)
• avoid straining or lifting anything heavier than your baby
• lying down can help relieve the pain. 

You should contact your midwife or hospital team or visit an emergency service if:

• your headache does not get better after taking over the counter pain relief
• the headache gets worse
• you are not able to care for your baby or do normal everyday tasks
• you have problems with your vision and hearing
• you feel sleepy, sick or confused. 

You may be advised to return to hospital so the healthcare team can assess you and ensure there are no other serious causes for your headache. If a dural puncture headache is suspected, one of the anaesthetists will review you. If you have a headache after childbirth, you can usually keep your baby with you in hospital. 

If the healthcare team thinks you have a dural puncture headache and painkillers do not help, you may be offered a procedure called an epidural blood patch. The procedure is very similar to having an epidural. This is normally offered a couple of days after the headache starts. Evidence shows that an epidural blood patch is more effective if carried out 48 hours or more after the severe headache starts.
 
During an epidural blood patch, a little of your own blood is taken from your arm and injected into your back. The blood seals the hole in the dura and stops more fluid from leaking out. This helps the pressure to build back up so that the headache gets better. You will need to lie flat for at least 1-2 hours after the procedure.

Out of every 100 people who had a blood patch, 60 to 70 felt better, 30 to 40 did not.

• The procedure might feel uncomfortable
• There may be bruising where the injection goes in
• It can cause backache and stiffness, which can last for a few weeks
• It could cause another puncture to the dura, which can make the headache worse.
• This risk is the same as getting a dural puncture headache in the first place.

You should seek medical help immediately from your midwife or visit A&E if you had an epidural blood patch and you:

• have difficulty passing urine
• experience faecal incontinence
• have severe back pain
• lose sensation or movement in your arms or legs
• feel unwell and develop a fever
• develop pus or redness around the site of the injection.