RANDOLPH W. EVANS, MD, FAAN, RESPONDS

Up to 30 percent of patients experience a headache after a lumbar puncture (also known as a spinal tap), a procedure that involves inserting a small needle into the membrane around the spinal cord at the lower back to draw out cerebrospinal fluid.

The headache, which is typically caused by spinal fluid that leaks out when the needle is inserted, is usually dull and throbbing and gets worse when you sit up or stand. Pain can range from mild to incapacitating and may be accompanied by dizziness, ringing in the ears, blurred or double vision, nausea, and neck stiffness.

Preventing Spinal Headaches

Lumbar punctures are performed to diagnose conditions such as meningitis and other infections in the central nervous system; neurologic diseases such as high-pressure headaches, multiple sclerosis, or Guillain-Barre syndrome, a disorder of peripheral nerves; or cancers of the brain. They are also used to deliver a spinal anesthetic for surgery.

The best way to prevent a headache is for the doctor to use what's known as an atraumatic needle, which is less likely to allow spinal fluid to leak. The brain floats in spinal fluid, and a leak reduces the volume of that fluid, causing the brain to sag inside the skull, which triggers a headache.

Treating Spinal Headaches

If you experience a headache after a lumbar puncture, tell your doctor immediately as he or she may prescribe oral painkillers. Often, the headache will resolve on its own; resting, staying hydrated, and having drinks with caffeine or caffeine supplements can help relieve the pain. If the pain is more severe when you stand or sit up, lying down may also help.

Risk Factors

Some people are more prone to these types of headaches, including females, adults ages 30 to 50, people with a history of headaches, and thin individuals.

Follow-up Treatment

If the headache persists, patients may benefit from bed rest, fluids, and intravenous caffeine. If the headache worsens, neurologists may perform epidural blood patching, a procedure that involves drawing blood from the patient's arm and injecting it into the spinal canal outside the dura in the lower back. The patch raises the fluid level, and usually relieves the headache. Doctors may have to repeat the procedure for complete relief.

If the headache still doesn't resolve, doctors may use a type of surgical glue to patch the hole where fluid is leaking or close the hole surgically with stitches or other material.