Post-dural puncture headaches can cause severe, unrelenting pain in the back of your head. If you have a headache like this that isn’t responding to painkillers, interventional pain management expert Ben Shamloo, MD, FIPP, of Shamloo Elite Spine and Pain Institute in Beverly Hills, California, can help. Call today to find out more about post-dural puncture headaches and whether you might have one, or book an appointment online.
Post-dural puncture headaches, or occipital headaches, affect the back of your head, causing constant, throbbing pain. The pain doesn’t improve, even if you take pain medications.
Post-dural puncture headaches develop when there’s a leak of cerebrospinal fluid from the dural membrane. The dural membrane is one of three membranes that cover your brain and spinal cord. These membranes are called the pia mater, arachnoid mater, and dura mater.
The pia mater attaches closely to the spinal cord. Between the pia mater and arachnoid mater, there’s a gap called the subarachnoid space. This is where the cerebrospinal fluid lies, as well as in the ventricles inside your brain. The dura mater surrounds the arachnoid mater.
If there’s a hole or tear in the dura mater, cerebrospinal fluid can leak out, leading to a post-dural puncture headache.
The pain of a post-dural puncture headache is due to the fall in pressure within the subarachnoid space from leaking cerebrospinal fluid. Blood vessels within the skull start to swell to fill the space. The enlarged vessels throb and cause the pounding pain of a post-dural puncture headache.
Post-dural puncture headaches can be due to a dural puncture. A puncture can occur when a doctor is performing surgery or giving an injection into the spinal cord, the epidural space (between the two layers of the dura mater), or the subarachnoid space.
A sharp instrument or needle can pierce the dura mater, and, because it’s attached to it, the arachnoid mater. As a result, cerebrospinal fluid can start seeping through, even if it’s just a minute breach.
Spinal anesthesia can be a source of a dural puncture. If the needle doesn’t go in exactly the right place the first time, it can cause a puncture. For example, epidural anesthesia, giving an epidural injection before performing surgery or a Cesarean section, is less likely to cause a dural puncture, but it’s still possible.
Surgery itself can also cause post-dural puncture headaches. Damage to the dura can occur during spinal surgery to replace a disc, for example, or any procedure where surgical instruments are coming in close contact with the spine. Usually, any damage is attended to during the procedure, but it’s possible for a leak to develop if a small injury isn’t repaired.
Treatment for a minor post-dural puncture headache is with a blood patch. Using X-ray guidance, Dr. Shamloo injects up to 15cc of your blood into the epidural space at the site of the leak. The blood fills the hole and clots, sealing the breach and preventing further loss of cerebrospinal fluid.
Stem cells and PRP (platelet-rich plasma) are also suitable for use in a patch treatment. These types of therapy are known as regenerative medicine and promote healing of the damaged dura as well.
If the leak is more severe, you would need to undergo surgical repair to stop the loss of cerebrospinal fluid.
Call Shamloo Elite Spine and Pain Institute today to find out more, or book an appointment online.