Spinal
headache, Post-Dural-Puncture Headache (PDPH).
Blood Patch, Epidural Blood Patch.
Headaches are a possible side effect of a spinal injection. In fact, they are the most common problem associated with these types of procedures. The incidence has varied from 0.2% to 24%, depending on several factors, including needle size and type. They are thought to result from leakage of spinal fluid (CSF = Cerebro-Spinal Fluid) into the epidural space, through the hole or tear made by the needle. This loss of fluid, that normally surrounds the brain and spinal cord, may cause the headache you are experiencing.
A blood patch is done when a patient has had a puncture in the sac that holds the spinal fluid. This puncture can occur after spinal anesthesia, epidural block, and myelogram or back surgery. The most significant symptom of this tear is a severe headache. The treatment of choice is a blood patch.
The headache usually occurs within the
first or second day of the spinal procedure. It can include pain in the
neck and shoulders, and is usually aggravated by sitting, standing or
coughing. You may feel nausea, vomiting, tinnitus (ringing in the ears)
or changes in hearing activity, experience a loss of appetite, and light may
hurt your eyes.
Conservative management is always
recommended, as the first step in treatment. Some studies suggest that
proceeding with a blood patch within the initial 24-48 hour after the
development of the PDPH, may result in a success rate of treatment of 40%,
compared to a success of 89% - 95%, when done after the initial 48 hours.
Conservative management consists of:
· Drinking plenty of fluids, in order to replace the lost CSF. 3 liters/day, unless contraindicated by renal failure, congestive heart failure, or any other medical condition for which such high intake may be deleterious.
· Absolute bed rest x 24-48 hours.
· Drink plenty of caffeine. Caffeine is supposed to accelerate the production of CSF in your body. An alternative may be intravenous caffeine 500 mg in LR (Lactated Ringers Solution), over a period of 30 minutes to an hour. Another alternative would involve using theophylline 200 mg by mouth, twice a day.
· Pain medicine to help with the symptoms.
This procedure requires that you lie on your side or stomach, with your back exposed. The doctor will clean the area with a special soap and then numb the area. The Blood Patch procedure for treatment of the headache involves placing a small needle in your lower back and locating the epidural space. After he puts the needle in the epidural space, the nurse or doctor will draw 5-20 cc of blood from your arm. The doctor will inject the blood through a needle into the epidural space. The blood will clot over the tear and stop the spinal fluid from leaking. You will need to lie flat for about 30 minutes after the procedure. Usually, you will feel some relief in 2 hours; however, complete relief may not be felt for up to 24 hours.
· You need to lie flat for 20-30 minutes after the procedure.
· You need to drink plenty of fluids. (3 liters/day, unless contraindicated by renal failure, congestive heart failure, or any other medical condition for which such high intake may be deleterious.)
· Try to drink a glass of water every hour while you are awake.
· Try to lie flat for the next 6-8 hours after the procedure.
· The success rate of the epidural blood patch is 89-95%. The procedure may be repeated 24 hours later if the initial attempt proves unsuccessful.
Occasionally after the procedure, you may feel soreness at the puncture site in your back, have a neck ache or a slight fever that may last 24-48 hours.
· Backache or soreness at the needle site (35%)
· Neckache (0.9%)
·
Slight temperature rise (24-48 hours
in duration) (5%)
· You develop a temperature of 101o for more than 24 hours
· The headache does not resolve or decrease after 24-48 hours