What Is A Post-Dural Puncture Headache (PDPH) And How Is It Treated?

The lining around the spinal cord is called the dura mater, and a dural puncture hole typically results from a lumbar puncture (spinal tap) or a myelogram. Or possibly when the patient is having an epidural injection or a spinal cord stimulator trial the dural sac (spinal cord) is punctured which is a normal complication but may not seal up like it should. The body replenishes its cerebrospinal fluid every 4 hours, so if a bit of CSF leaks out after one of these procedures and the hole seals up as it usually does rest of the CSF will be replaced very soon.

Usually if a patient undergoes one of these procedures, any residual hole from the needle used will seal up on its own very quickly. The body knows it's not supposed to have a hole in the dural sac, so it seals it. If the hole persists, cerebrospinal fluid will leak out into the epidural space. This may create a situation where structures in the skull gradually shift downwards from gravity where the liquid is seeping out. Since the cerebrospinal fluid runs from the brain all the way down the spinal column within the spinal cord, if it's draining out, the skull structures shifting downwards will stretch sensitive fascial and ligament structures. Cerebral vessels become dilated, and a major headache will result.

This is called a post-dural puncture headache. These headaches are very very painful while sitting upright or standing and tend to dissipate when laying down. Other symptoms include neck stiffness and pain across the upper back along with sensitivity to light (photophobia like a migraine).

Treatment for a post-dural puncture headache include bedrest, which alleviates symptoms and create a situation where the hole may spontaneously close. Hydration and pain medication may help to facilitate extra CSF production. Caffeine may help constrict vasodilated cerebral vessels and help symptomatically with the headache.

If these methods do not work, an epidural blood patch may work beautifully. If you have had a procedure where the dural sac was potentially "poked" either intentionally or unintentionally and the symptoms of a post-dural headache are persisting, try laying down and see if it dissipates. Then call your doctor for further instructions for treatment. It is a common complication and often responds to one of the above treatments.