From the Guidelines
The management of post-spinal anesthesia headache primarily involves hydration, caffeine, analgesics, and if necessary, an epidural blood patch. Initial treatment should include bed rest, increased oral fluid intake, and caffeine consumption (200-300 mg orally every 4-6 hours or intravenous caffeine sodium benzoate 500 mg) 1. For pain relief, acetaminophen (1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6 hours) can be used.
Key Considerations
- The use of greater occipital nerve blocks may be offered to patients with post-dural puncture headache (PDPH) after spinal anesthesia with a narrower-gauge needle, although headache may recur in a substantial proportion of patients 1.
- Epidural saline may be of temporary benefit but should not be expected to provide long-lasting relief of PDPH 1.
- Fibrin glue should be reserved for management of PDPH refractory to epidural blood patch (EBP) or when autologous blood injection is contraindicated 1.
Treatment Approach
If these conservative measures fail after 24-48 hours, an epidural blood patch should be considered, which involves injecting 15-20 mL of the patient's autologous blood into the epidural space at or near the site of the dural puncture. This procedure has a success rate of 70-90% for the first attempt 1. The blood patch works by forming a clot over the dural tear, preventing further CSF leakage. Other medications that may help include gabapentin (300-600 mg three times daily), cosyntropin (1 mg IV), or theophylline (200-300 mg orally every 6-8 hours). Patients should be advised that most post-dural puncture headaches resolve spontaneously within a week, but prompt treatment improves comfort and functionality. Imaging is not typically indicated in this clinical setting because postdural puncture headaches are typically self-limited, with most symptoms fully resolving within 1 week without any treatment 1.
From the Research
Management of Headache Post Spinal Anesthesia
The management of headache post spinal anesthesia involves a variety of approaches, including:
- Conservative treatments such as bed rest and oral caffeine for mild cases 2
- Epidural blood patch (EBP) for moderate-to-severe cases, which remains the most effective treatment 2, 3, 4
- Other less invasive treatments such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, and greater occipital nerve blocks, which have shown promise but require further study 2
- Identification of predisposing factors such as female sex, young age, pregnancy, low body mass index, multiple dural puncture, and past medical history of chronic headache, to minimize the risk of post spinal puncture headache (PSPH) 5
Treatment Options
Treatment options for headache post spinal anesthesia include:
- Epidural blood patch, which is indicated for severe or persistent headaches 6, 3, 4
- Conservative management, which involves bed rest, hydration, and pharmacological management 2, 4
- Nerve blocks, which are highly efficient alternatives for patients who do not respond well to conservative treatment 4
Prevention
Prevention of headache post spinal anesthesia involves: