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Epidural Headache With A Late Onset
My story is unique in that I had an epidural headache which started on 25th January 1998, 3 weeks and 2 days after childbirth. It was considered to be unheard of starting this late after childbirth and was brushed aside by the anaethesists as a tension headache! They couldn't have been more wrong. Having an epidural headache was the most excruciating sort of pain I could have ever imagined having and this was after a very long, difficult, induced (for pre-eclampsia) and posterior (back-to-back) childbirth.
An epidural headache, also known as post dural puncture headache, post lumbar puncture headache or spinal headache is postural in nature, so that when you stand up it is unbearable and when you lay down it usually goes completely within seconds. Some people are lucky enough to get them mildly (if you can say lucky!). I had to literally crawl around with my head down to move about in the house until I found out that caffeine helps with these headaches. (Even then, it didn't always work). Pain killers don't seem to have any affect on this sort of pain - a pethidine injection in hospital had no effect on it at all when I was in an upright position! Codeine (60mg)/paracetamol (1000mg) didn't touch the pain either.
An epidural headache occurs when the dura (the covering outside the spinal cord) is punctured by the needle. CSF (spinal fluid) which bathes the spinal cord and brain then leaks out of the hole created by the needle. You don't always get an epidural headache when this is happens and sometimes the anaethesist may not even notice fluid leaking from the site but still an epidural headache occurs!
Usually an epidural headache or post dural puncture headache will last a couple of days or maybe even a week and heal itself, but not always (as in my case).
An epidural headache is usually relieved by caffeine which is the first line of conservative treatment (I would drink about 8 cups of coffee a day when I had mine, having never drunk tea or coffee in my life!). If they are not gone within a few days, a blood patch should definitely be done. This is where they take some of your own blood from your arm and inject it into the epidural space in your back. It clots there and seals the leak. I had my epidural headache for 3 months before a blood patch was done on me and it fixed the terrible pain pretty well straight away (this was a horrible nightmare, having a newborn to care for as well). I also suffered severe neck spasms, extreme hearing loss and ringing in the ears while I had this excruciating low pressure headache.
The risks of having a blood patch are the same as all the risks of having the original epidural + a small risk of meningitis. The risks of not having a blood patch when you have leaking spinal fluid (CSF) are brain herniation also called an Arnold Chiari Malformation (ACM) which happens in about 80% of cases. It is reversible with a blood patch although a CSF leak can make symptoms worse if you already had a herniation before the leak began, even after the leak has been fixed. This is why the World Arnold Chiari Malformation Association (WACMA) does not recommend epidurals or lumbar puncture unless your life depends on it if you already have ACM (incidently some people who have been told for years that they have conditions like Chronic Fatigue Syndrome and Fibromyalgia are finding out (through MRI) that they actually have an Arnold Chiari Malformation - but that's another story! Take a look at the WACMA site for list of symptoms if you're interested, they have excellent, up-to-date information). Sub-dural haematoma, cranial nerve palsies and even blindness are other rare complications of a CSF leak. A blood patch should not be done within 24 hours of it's onset as there is a very high risk of failure if it is done within this time.
The terrible pain is caused by having a low pressure of CSF around the brain, and the brain rubbing painfully against the skull with very little cushioning of CSF each time you are upright. The brain also tends to sag all over. These headaches can be diagnosed by having an MRI which usually shows diffuse meningeal enhancement and brain sagging. There are various medical journals which you can search for on this see Epidural.net home page.
I have put some of my story on the internet because I want others to be aware that a post dural puncture headache or post lumbar puncture headache can occur (however rare) this late after having an epidural, spinal anaesthesia, diagnostic lumbar puncture or myelogram. You can even get a spontaneous low pressure headache which is exactly the same but starts suddenly without any specific event causing it.