Differential Diagnosis for Spinal Headache
- Single most likely diagnosis
- Post-dural puncture headache (PDPH): This is the most common cause of spinal headache, occurring after procedures that involve puncture of the dura mater, such as lumbar punctures or epidural injections. The headache is typically worse when standing and improves when lying down.
- Other Likely diagnoses
- Spontaneous intracranial hypotension (SIH): This condition is characterized by a spontaneous leak of cerebrospinal fluid (CSF), leading to low CSF pressure and causing headaches that are often worse when standing.
- Cervicogenic headache: Referral of pain from the cervical spine to the head, which can mimic a spinal headache. It is often associated with neck pain and stiffness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH): Although less common, SAH can present with a sudden, severe headache and should always be considered in the differential diagnosis of any acute headache, including spinal headaches.
- Meningitis: Infection of the meninges can cause severe headache, fever, and stiff neck. Early diagnosis and treatment are crucial to prevent serious complications.
- Rare diagnoses
- Chiari malformation: A structural defect in the cerebellum that can cause headaches, often worsened by coughing, sneezing, or straining, due to increased intracranial pressure.
- CSF leak due to trauma: Traumatic injuries can lead to a leak of CSF, resulting in low CSF pressure and headaches that are typically postural.