What is a Post-Dural Puncture Headache? How can it be treated? The dura mater is the lining around the spinal chord. A dural puncture hole usually results from a lumbar puncture, a spinal tap, or a myelogram. Sometimes, the dural sac (spinal chord) may be punctured during an epidural injection. The body replenishes cerebrospinal fluid every four hours. If a little CSF leaks after one of these procedures, the hole will seal up quickly.
Most patients who have undergone one of these procedures will find that any remaining needle shards will close up quickly. The body knows that it is not supposed to have a hole within the dural sac so it seals it. If the hole persists, cerebrospinal liquid will leak into the epidural space. This could lead to the skull structures shifting downwards due to gravity. The cerebrospinal fluid runs from your brain all the way to the spinal column.
If it’s drained out, the skull structures will shift downwards, stretching sensitive ligament and fascial structures. A major headache can result when the cerebral vessels dilate. This is known as a post-dural headache. These headaches can be very severe if you are standing or sitting up. They tend to disappear when you lay down.
Other symptoms include stiffness in the neck and pain on the upper back, as well as sensitivity to light (photophobia) similar to a migraine. Bedrest is a treatment for a post-dural headache. This will relieve symptoms and allow the hole to close naturally. Hydration and pain medication can help increase CSF production.
Caffeine may be able to constrict vasodilated cerebral veins and alleviate headache symptoms. An epidural blood patch might be a solution if these methods fail. If you have suffered from a procedure in which the dural sac may have been “poked” intentionally or unintentionally, and are still experiencing symptoms such as a headache after the procedure, you can try lying down to see if the headache disappears.