An epidural headache is a headache that can occur after an epidural injection. It’s also known as a post-dural puncture headache (PDPH) or a spinal headache.

While you may think of childbirth when you read “epidural,” healthcare professionals actually administer epidural injections for multiple reasons, including as anesthesia for surgery, pain management, spinal cord stimulator placement, and more.

While epidural headaches can a side effect of epidural injections, they’re not usually serious. Keep reading to find out more about these unique headaches.

Your spinal column is a complex network of nerves, veins, arteries, fat, and more protected by your spinal bones that run along the center of your back.

Multiple layers exist outside the spinal column to protect the spinal cord and the nerves that come out of the spine. There are two specific spaces that healthcare professionals may access to administer medications to achieve certain effects: the epidural and subarachnoid spaces.

If a healthcare professional seeks to inject medication into these spaces, there are several areas the needle must travel through. These include, in order from closest to your skin to deepest:

  • supraspinous ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space
  • dura
  • subarachnoid space

The epidural space is just that: a space that contains air. The subarachnoid space contains fluid, also known as cerebrospinal fluid (CSF).

The goal of epidural injections is to identify the epidural space without inserting a needle through the dura into the subarachnoid space (basically going too far). When this happens, the needle punctures the dura. In some people, this effect causes a small area where CSF can leak into the spine.

You can experience an epidural headache if the healthcare professional accidentally punctures the dura. The slow leak of CSF affects the pressures in your spinal column, and the results can be a headache.

Not all people who experience an accidental dural puncture get a headache. Those who do may have symptoms such as:

  • dull, throbbing headache
  • headache that gets worse when standing up
  • headache that gets better when lying down

Experiencing this headache type can be a real challenge if you’ve just given birth or needed epidural injections for pain. The headache limits your activity because it gets worse if you’re standing and moving.

Are spinal headaches dangerous?

Spinal headaches aren’t usually dangerous and will resolve with time. However, there are rare cases where some people experience headache symptoms for up to a year after their epidural.

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The most definitive treatment for epidural headaches may sound odd: an epidural blood patch (EBP). It involves drawing your blood from a vein, then injecting it into the epidural space.

Yes — you read that right. The solution to epidural headaches is to actually perform another epidural, but to inject blood in the epidural space. This treatment is between 61 and 98 percent effective in treating epidural headaches. Most people who undergo an EBP experience immediate relief in their symptoms, according to a 2020 review.

Doctors don’t really know exactly how the EBP works to relieve the epidural headache, but they know it’s very effective. The current thoughts are that it helps to increase CSF pressure and help the puncture heal faster.

Most epidural headaches aren’t comfortable, but they don’t necessarily require treatment because they will get better with time.

However, if you can’t get through your day-to-day activities because of your headache, call your doctor about getting an epidural blood patch.

Epidural (or spinal) headache treatment at home

If you’re not sure you want to go back to a hospital or healthcare facility to get a blood patch, there are some steps you can take at home to try and see if your headache will get better.

These steps include:

If these don’t relieve your symptoms, you may need to consider an epidural blood patch.

Most epidural headaches will go away within 1 week after you’ve had an epidural injection or epidural block.

You don’t technically have to get any treatment for an epidural headache, because most of the time, the headache will go away on its own when your body repairs the punctured area.

Researchers don’t know exactly how often epidural headaches occur, but estimates range from 6 to 36 percent. If a smaller needle (25 gauge) is used, the risk drops to less than 1 percent.

Some people have risk factors that increase their chances of developing an epidural headache. These include:

  • being assigned female at birth
  • a history of previous epidural headaches
  • having low body mass index
  • low cerebrospinal fluid pressure
  • a history of pregnancy
  • younger age

The volume of CSF removed plays a role, too. The risk of spinal headaches increases if more CSF fluid has to be removed (20 to 30 milliliters).

People assigned male at birth and people with overweight are less likely to experience an epidural headache.

A healthcare professional should review the benefits and risks of epidural injections with you. They should also explain any alternative options you have to epidural injections if there are any.

Serious and long-term complications of epidural injections are rare but can happen. Examples include:

Again, these side effects are very rare. Make sure to let your doctor know about any concerns you have about getting an epidural, and they’ll be able to discuss more with you.

When should you go to the ER for a spinal headache?

Epidural or spinal headaches can be similar to a lot of serious medical conditions, including meningitis, epidural hematoma, and epidural abscess.

Even if the symptoms are very treatable (like an epidural blood patch for a headache), it’s a good idea to get checked out if you can’t manage your symptoms at home.

A spinal headache should not cause symptoms like high fever, problems walking, or severe, shooting pains down your legs. If you experience these symptoms after an epidural, seek emergency medical attention.

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Epidural headaches can be a side effect of epidural injections or epidural anesthesia.

However, not all people who receive epidurals get this headache, and there are treatments available. You must weigh the risks of the epidural versus the benefits, such as pain management.