What is a spinal headache?
Spinal headaches are a type of headache that occurs when the pressure in the skull becomes low, usually from a loss of the spinal fluid that surrounds the brain and the nerves in the spine. The headache that results from a loss of spinal fluid is unique in that the headache is much worse when standing, and almost resolves by simply lying down.
The headache can be accompanied by many other symptoms, including neck stiffness, pressure in the back of the head, nausea and vomiting, light sensitivity, decrease in hearing, and pain down the arm. In some cases, the headache pain is so severe the patient can not stay upright.
What causes a spinal headache?
The are several causes of spinal headaches. Most commonly, patients get spinal headaches as a rare complication of a lumbar puncture, or spinal tap. A hole is left in the covering of the spine from the needle placement, and cerebrospinal fluid leaks from the hole.
Other causes of spinal headache include trauma to the spine and brain and surgery to the spine or brain.
In all these cases, the cause of the leak is well defined. However, in a subset of people, a spinal headache occurs with either no trauma or simply minor trauma. It just begins, either slowly and gets worse, or suddenly as a major severe headache. In either case, the patient experiences a headache that improves within 30 minutes of lying flat, and will get significantly worse within 15 minutes of being upright. This type of spinal headache is known as spontaneous intracranial hypotension, and is the subject of this website.
How could someone get a spinal fluid leak without any surgery, trauma, or spinal tap?
It has been found that the thick, tough covering of the spinal cord, called the dura, can balloon out, especially where the nerves leave the main spinal cord and go to the rest of the body. This ballooning phenomenon is called a diverticulum. The diverticulum can leak CSF fluid. In other cases, the dura around the nerve roots coming out of the spinal cord is weak or frayed, allowing seepage of CSF.
It is not clear why some people suffer from this problem. It is known that a certain subset of people with spinal fluid leaks have signs of other diseases that cause problems with special tissues called connective tissue. These people often have very mobile joints, have problems with heart valves, have displaced lenses in their eyes, and other signs of "loose tissue". Several diseases can be associated with this problem. Most people with CSF leaks do not have this problem, however, and the cause of their dural tears and diverticulae are unknown.
How does someone know if they have this problem?
This type of headache is very distinctive. It is a headache that gets dramatically worse when someone stands up, and gets dramatically better when they lay down. If a person gets this type of headache in the absence of any accident, trauma, surgery, or spinal taps, it is likely they have this problem.
Is there a test for this type of spinal headache?
For someone suffering from a spinal headache, there is a procedure that can help the headache and in many cases provide relief. If the procedure is successful, even temporarily, it generally means the patient does indeed have a spinal headache.
The procedure is called an epidural blood patch. It involves taking a small amount of the patientís own blood, and injecting it into the space between the dura and the bony spine known as the epidural space. After injection, the patient usually feels immediate relief. In some cases, the relief may be permanent, but in many cases of spontaneous intracranial hypotension, the patientís headache returns in a few days, as they are still leaking.
Other tests that can be done include a lumbar puncture, or spinal tap, that can measure the pressure of the spinal fluid and see if it is low. Although spinal fluid pressure is usually low in patients with spontaneous intracranial hypotension, it is occasionally normal. This is presumed to be due to variations in the spinal fluid pressure.
MRI scans can be very useful. When the MRI is performed with certain contrast agents, the scan may reveal a pattern that has been closely related to spontaneous intracranial hypotension.
Finally, if blood patches do not help the patient, physicians can look for a leak directly. This is done by injecting a special dye into the spinal fluid, and then performing a CT scan of the entire spine to look for leaks. Results of these tests are not always clear cut and straightforward, but in many cases leaks can be located.
What happens after a specific leak is found?
Several options are available if a specific leak site is located, and the patient is still having positional headaches. Special glue can be injected into the leak site under x-ray guidance. In some cases, successful placement of the glue seals the leak and stops the headache.
In other cases, surgery is necessary. During surgery, the leaking area is exposed and patched with glue along with other materials to close the leak and hopefully prevent re-leaking. In many cases, surgical repair is curative.
What is the outlook for a person with a CSF leak?
Most patients respond to blood patches, and surgery if necessary. Some patients have more than one site that leaks, requiring multiple procedures to try to fix the leaks. Some patients continue to have positional headaches in spite of leak repairs. In rare cases, the headache stops being positional and becomes constant.
Where can I go for more help?
Try find a neurosurgeon or neurologist who is familiar with this problem. Many neurologists and neurosurgeons are unfamiliar with spontaneous intracranial hypotension and may explore other directions before coming to a correct diagnosis.
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