What Is An Epidural Headache? - Questions and Answers About Epidural Headaches 1. What Causes An Epidural Headache? An epidural headache is caused by leaking spinal fluid when the dura which is the thin membrane that surrounds the spinal cord is punctured by an epidural needle. The fluid acts as a cushion around the brain and without it, the brain tends to sag and rubs painfully against the bony skull. This brain sagging causes stretching in the connective tissues in the cranium which also causes pain. A further cause of pain is the loss of Cerebral Spinal Fluid (CSF) which causes blood vessels in the brain to dilate. 2. How is an epidural headache different to other headaches? Epidural headaches are typically postural headaches, meaning that standing or sitting upright or even lifting your head will dramatically increase the pain whereas laying down relieves the pain almost instantly. Of course you can still suffer from other types of headaches at the same time (tension headaches and migraine headaches could be aggravated and therefore more frequent because of the leaking spinal fluid, so it is possible to still have a headache when you lay down). Severe headache usually with sudden onset needs to be investigated immediately because of the rare but real possibility of subdural hematoma or meningitis. Also, a change in headache for example where a headache which was previously relieved by laying down suddenly appears regardless of position, a subdural hematoma caused by bleeding on the brain needs urgent investigation – “Of note, a change in headache pattern should alert the physician to the possibility of development of complications, such as subdural hematoma or cerebral venous thrombosis (Lai et al 2007b; Schievink and Maya 2008). Please read Norman’s story 3. What is the Severity of the Pain Associated with Epidural Headaches? Epidural headaches can vary in intensity from mild, moderate, but are often described as severe and excruciating pain located in the sub-occipital region (back base of the head) or bi-frontal (front of head). The headaches can be incapacitating causing the sufferer to be bed-ridden and needing care. 4. What Relieves the Pain of Epidural Headaches? Caffeine will often temporarily relieve the pain associated with the postural headache because it increases the production of CSF (Cerebral Spinal Fluid) in the brain. It is important to keep hydrated because this also helps to increase the spinal fluid production. These methods are often the first line of treatment to see if the leak will heal itself naturally. If the headache is still there in 48 hours, a blood patch should be done. A blood patch will work 90% of the time, sometimes another one is required. 5. What Other Symptoms Are Associated With Epidural Headaches? Other symptoms can include visual changes such as sensitivity to light or double vision, nausea, neck pain, decreased hearing, and tinnitis (ringing in the ears). 6. What Are The Potential Complications Of Having An Epidural Headache? Left untreated, an epidural headache can rarely cause subdural hematoma (caused by bleeding on the brain or brain hemorrhage) due to stretching of the blood vessels resulting from stretching and tearing of veins. Long term CSF leaking has also been documented to have caused blindness and deafness. CSF leaks have been documented to have caused dementia which was fixed through surgery, these were not associated with epidural punctures, but dural tears, nevertheless the same mechanism was responsible for the complications. Being in chronic and unrelenting pain has long term effects of it’s own including considerable stress and possible depression and for those who have newborns to care for, this makes it extremely difficult. 7. How Long Will My Epidural Headache Continue? Left untreated, an epidural headache will usually heal itself within a few days. Unfortunately for some of us, they can also go on for many months and will persist until the leak is closed either by blood patch or surgical intervention (rare). There have been a couple of reported cases of CSF leaks going on for years, but these were associated with tears of the dura. 8. What Other Names Are There For This Sort of Headache? Postural headache, spinal headache, post dural puncture headache, pdph, lumbar punture headache, low pressure headache, intracranial hypotension, some people can get tears in their duras through an accident or even spontaneously (spontaneous intracranial hypotension). The leak can also be anywhere in the spine or head. Leaking fluid from the nostrils can be a sign of csf leak somewhere in the head, and this can cause meningitis. No matter what the cause, these sort of headaches need medical attention. Please read a personal story, Epidural Headache With A Late Onset