Epidural Headaches – Causes And Treatment
Around 30% of women in Australia, and well over 60% of US women have epidurals during labour. Some of these report suffering from epidural headaches.
Epidurals are given during labour for a number of reasons, including the need to rest after a long labour. Some women have them because they have been induced, or they are not coping well with labour pain.
A spinal block is less commonly used during labour as the anaesthetic is a once-off injection.
Spinal blocks are more likely to be used during a c-section, when a general anaesthetic isn’t an option or unnecessary.
Find out more in Spinal Or Epidural Blocks – What’s The Difference?.
Epidural Headaches – Causes And Treatment
Between 1% and 3% of women who have epidurals experience what’s known as an epidural headache after the birth of their babies.
Properly called a postdural puncture headache, this is a debilitating side effect of having an epidural or spinal block.
What Causes An Epidural Headache?
The brain and spinal cord are contained inside a bag of fluid called the dura. When an epidural is placed, a needle is inserted into the spinal area just outside the dura. Local anaesthetic is injected into this space; this produces the effects of the epidural.
If the needle passes through the dura, it allows spinal fluid to leak out, which changes the fluid pressure around the brain and spinal cord. In an attempt to maintain pressure, the vessels around the brain dilate and fill with more blood, causing the headache.
A headache can also occur if a spinal block is given instead of an epidural. During a spinal block, a very fine needle is inserted directly into the dura to inject anaesthetic into the spinal fluid. If fluid leaks out through the hole in the dura, pressure in the fluid and around the brain is reduced.
This is less likely to occur during a spinal block than during an epidural procedure. Epidurals require a much larger needle than spinal blocks do. The likelihood of a dura puncture increases with the size of the needle used.
Even in experienced hands, a dura puncture can occur. Although epidurals are a common procedure, teaching the correct technique of epidural insertion is a challenge, according to Dr Matt Rucklidge, a specialist anaesthetist at King Edward Memorial Hospital in Perth.
Dr Rucklidge told a large meeting of anaesthetists in Sydney more research was needed to reduce the incidence of postdural headache.
“Teaching the epidural technique is not straightforward, as key steps of the procedure require an appreciation of the ‘feel’ of the tissues as the needle is advanced”, Dr Rucklidge reportedly explained.
“If we can provide better and more focused training this may result in fewer headaches – not just for our patients but for those learning and teaching this challenging procedure”, he said.
“When they wheeled me back to recovery, I could hear women screaming in pain in the rooms around me. As the hours passed, a nurse finally told me that the training anaesthetist had messed up and the women had spinal headaches. My heart broke for them. I heard one in another room scream that the morphine wasn’t even working”.
What Are The Symptoms Of An Epidural Headache?
Headaches following spinal or epidural blocks can occur up to five days after the procedure is performed. Most women will notice symptoms are intensified when they sit up. This is because being upright reduces the pressure around the brain even more.
A postdural puncture headache is described as the worst migraine imaginable. The headache is felt at the front or back of the head and is worsened when sitting or standing.
Other symptoms which might accompany the headache are:
- Nausea and vomiting
- Neck stiffness or pain
- Dislike of bright light (photophobia)
- Cranial nerve palsies (blurred or double vision, drooping eyelid, enlarged pupil, inability to control eye movement).
- Lower back pain
Understandably, the effects of an epidural headache can be debilitating. New mothers might need to stay in hospital for longer periods than expected. This can have an impact if they have other children at home needing to be cared for.
Being unable to stand or sit can have huge ramifications, in terms of a new mother’s ability to bond with, and care for her baby. She can’t sit to breastfeed or even hold her baby, which means extra support is necessary to ensure both her needs and those of the baby are met.
“I felt awful; my brain felt as though it was pounding outwards, while my whole skull felt as though it was being crushed inwards. I was nauseated, and it felt like a big effort to focus my eyes although I could see well when I did. I was also dizzy, and had difficulty keeping my head steady, though moving actually caused more pain.
“Moving my head or neck, or even my eyes, sent shooting pains that increased the crushing pressure and gave a stronger wave of nausea. I struggled through feeding my baby first of all, but when I sat fully upright to lay him at my feet to change his nappy, another pain shot through my head so sharply I could see it behind my eyes and I vomited immediately from the pain”.
Experiencing such severe side effects of an epidural can also lead to extreme anxiety and even trauma. Women who go on to give birth again might become extremely concerned they might have the same experience.
Other women recall the headache, and the subsequent separation from their babies, as traumatic experiences.
“Long term, I suffered extreme anxiety regarding a repeat epidural for my second birth”.
Can Postdural Puncture Headaches Be Treated?
Without treatment, the hole in the dura will mend itself within a few days or weeks.
Lying flat and taking pain relief medications such as paracetamol and ibuprofen might be the only necessary treatment for a post dural puncture headache. You should also drink plenty of fluid to increase the pressure of the spinal fluid. Some people find it helpful to drink beverages high in caffeine, such as tea or coffee. Strict bed rest might be recommended, and heavy lifting or straining should be avoided.
A severe postdural headache will probably need to be treated by what is known as a blood patch. This procedure is very similar to an epidural and takes around 30 minutes.
First, a sample of blood is taken from your arm. The anaesthetist then inserts a needle into the same space or just next to the area where the anaesthetic was injected. The blood taken from your arm is injected into the epidural space, sealing the hole causing the leak.
About 60-70% of women with a postdural puncture headache will have relief within 24 hours of having the blood patch. If the headache continues, or stops and then returns, a second blood patch can be given, or caffeine therapy might be offered while the hole heals.
“The blood patch process was very quick and efficient. I think I was back in bed within half an hour, and I could feel my headache easing even as the blood was being injected”.
A blood patch can cause local bruising and backache which lasts for a few days. There is also a chance the blood patch could cause another accidental puncture.
Having an epidural is a personal decision and every woman has the right to be informed of the potential side effects.
Women who choose to have an elective epidural, or are considering one for labour, should discuss the risks with their anaesthetists and find out what level of experience they have for epidural insertion.