What is a Spinal Headache?
Before we get into the meat of this article this isn’t about bashing epidurals - at GentleBirth we believe that an epidural can be a wonderful tool in labor and suggest keeping everything on the table for the big day.
If you have an epidural in labor when you sign your consent form for your epidural you’ll be informed about the risk of having an epidural headache (also know as a spinal headache or post dural puncture). If you have asked for an epidural it’s unlikely you want to spend any time discussing the pros/cons of an epidural - you just want to not feel pain anymore. This article will give you a little more information about spinal headaches and provide you with some options to discuss with your careprovider if you find yourself experiencing one.
What is a Spinal Headache
About 1 in 100 people in the US will experience an accidental dural puncture during the insertion of the epidural. It’s about 1 in 200 in the UK. What it means is the anesthetist accidentally punctured the protective seal around your cerebrospinal fluid. It’s the third most common reason for a postpartum headache in the days after birth. The pain is thought to be caused by the leaking of fluid from the membrane of the brain causing what can feel like a really bad migraine.
It’s usually only discovered after labor when you feel a blinding headache and any movement makes it worse so you’re left lying flat…can’t nurse your baby and feel miserable. Some people feel worse lying down so it may manifest differently for you. Bedrest isn’t recommended but it’s likely that you might not want to get out of bed but that can cause other problems postpartum such as increasing the risk of blood clots.
Is It Dangerous?
Thankfully no - but when you’ve just given birth and you’re told that you’re leaking spinal fluid - that can be quite alarming. Without treatment it is likely to resolve itself within a week - but you have a newborn to take care of so waiting isn’t really an option for most.
Why else would you have a headache?
Just because you have a headache in the days after labor doesn’t mean you need a blood patch. Dehydration, withdrawal from your morning coffee or preeclampsia can all result in headaches. Talk to your careprovider if you experience headaches in the days after labor.
While You’re Waiting for a Blood Patch
It’s likely that you’ll be offered IV or oral caffeine. Caffeine causes the blood vessels in the brain to constrict and can help reduce pain. Research suggests that 300g is the recommended dosage. You may be offered other medications that include narcotics so talk to your careprovider about options. IV Cosyntropin may be offered if you’re not a good candidate for a blood patch.
This website includes the caffeine content of popular drinks and supplements.
Acupuncture
Yes more needles! If you haven’t been completely put off needles then acupuncture may be worth considering. It has been shown in some case studies to significantly relieve pain due to a spinal headache almost immediately and may be worth considering if you prefer not to try another approach before agreeing to a blood patch. (Don’t worry the needles don’t go anywhere near your spine).
Epidural Blood Patch
If you’ve experienced this complication you’ll be offered an epidural blood patch. You’ll be taken to theatre and some of your blood will be taken and injected into your spine slowly to seal off the leak. Keep in mind that you’re not in labor so you’ll find it easier to get into position for the procedure and won’t be thinking about the next surge coming midway through. Most women find it gives them immediate relief and sometimes a second EBP is necessary.
What are the Risks to the Procedure?
Some local pain at the injection site in your back and just like any injection there’s a chance of bleeding or infection.
Are there any reasons why I couldn’t or shouldn’t get it?
You’ve every right to be a little nervous about someone sticking another needle in your spine after not doing a great job the first go round. Your careprovider will explain the pros/cons and if there is any reason why you shouldn’t have this procedure for example if you have a blood infection or a clotting disorder.
I don’t fancy another needle in my spine - are there any other options?
Yes - an SPG. The video below demonstrates a ‘Sphenopalatine Ganglion Block’ (it looks a little like a Covid test). A local anesthetic is distributed on specific nerve endings far back in the nasal cavity. It only takes a few minutes and is minimally invasive.
Potential Risks include discomfort when the tubing or syringe like device is inserted. You might experience a numbing sensation when swallowing (as some of the anesthetic will run into the back of your throat. Nausea and/or light-headedness are the most common side effects reported. As it’s an anesthetic there is a risk of an allergic reaction too. Talk to your careprovider about all of your options.
Do you know what percentage of people need blood patches in your hospital after an epidural? That might be useful information to know.
I hope you find this information helpful.
Tracy
