• Reference Number: HEY202/2025
• Departments: Anaesthetics
• Last Updated: 30 June 2025

Information you need to know

This leaflet has been produced to give you general information about your headache that has developed after your spinal/epidural injection. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your anaesthetist but may act as a starting point for discussion. If, after reading it, you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

Introduction

Headache after childbirth is common whether it is a normal birth or Caesarean delivery. However, after having an epidural or spinal injection, you have between 1 in 100 and 1 in 200 chances of developing a ‘post dural puncture’ headache.

The headache typically occurs between one day and one week after having the epidural or spinal injection. It is usually a severe headache felt at the front or back of your head, which gets better when lying down and worse on sitting, standing, straining and bending forwards. Along with the headache you may experience neck pain, sickness and a dislike of bright lights.

Women, after childbirth, are more likely than other people to experience post dural puncture headache.

What causes the headache?

The brain and spinal cord are contained in a bag of fluid. When an epidural is placed in the lower back, a needle is used to position a fine tube called the epidural catheter just outside the bag of fluid.  Local anaesthetic is injected through the catheter to provide relief from labour pain. Occasionally the needle can accidentally make a hole in the dura.  When a spinal anaesthetic is given, a fine needle is inserted intentionally through the dura to inject local anaesthetic into the bag of fluid.

The headache is caused by some fluid leaking out of the dura, which decreases the fluid pressure around the brain. Some patients describe this as a very bad migraine which is made worse by sitting, standing up and straining.

What can be done about the headache?

Bed rest and simple pain killers (such as paracetamol and diclofenac) may be the only treatment you need. You should drink plenty of fluid (some people find tea or coffee especially helpful) and avoid lifting heavy weights or straining. There are other alternative treatments available but none of them has been shown to be effective.

Usually, the headache resolves spontaneously in a few days but if it does not, your anaesthetist may offer you a treatment called a blood patch. (Epidural Blood Patch leaflet)

How do I prepare for this?

At this stage, you are advised to stay in the hospital, so that regular follow up can be carried out. However, if you decide to go home, make sure that some immediate help is available for you for the next 2 or 3 days. You should leave your direct contact number with your healthcare team, so that they can call you to enquire about your well-being.

What will happen?

Anaesthetists will come and assess you, first to confirm that the headache has been caused by the epidural or spinal that you have had. If in doubt, they may seek advice from other specialist doctors or sometimes may arrange for tests (such as a head scan).

Once the diagnosis is confirmed, the anaesthetist will discuss the treatment with you.  You may be prescribed regular pain killers and laxatives (to make bowel motions easier).  You will also be encouraged to drink water and to avoid lifting heavy weights.

What happens afterwards?

An anaesthetist will come to see you regularly for the next 2 or 3 days or phone you if you have gone home, to check that you are recovering satisfactorily. Most patients will report an improvement in their condition at this stage or are now able to cope with the headache. If, however, you are unable to cope and find the headache is severe, worsening and/or prolonged, you may be offered a blood patch at this stage. (See leaflet “Epidural Blood Patch – What you need to know”)

Most of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion with your doctor.  If you have any queries, please write them down so that you can ask your anaesthetist when he or she comes to assess you.  Please do not hesitate to voice any doubts, however silly they may sound to you.

How much do I need to know?

Some people want to know as much as possible about their condition and possible treatments; others prefer to leave decisions to the experts. No one providing healthcare will force information on you, for example, about the risks of treatment if you don’t want to know. But remember, the person in the best position to know what matters most is you.

This leaflet was produced by the Anaesthetics Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in June 2028.