The Primary Causes of Post-Lumbar Puncture Headache

One of the most common reasons for headaches following a lumbar puncture is the leakage of cerebrospinal fluid (CSF) during the procedure. During spinal anesthesia, a needle is inserted through the lower back, passing through several ligaments including the supraspinous and interspinous ligaments, as well as the ligamentum flavum, to reach the subarachnoid space within the spinal canal. When CSF leaks from the puncture site, it can cause a decrease in CSF pressure around the brain and spinal cord, leading to what is known as a post-dural puncture headache.

Why Does CSF Leakage Cause Headaches?

This type of headache typically occurs due to the reduced pressure exerted by the cerebrospinal fluid surrounding the brain. The headache is often positional, meaning it worsens when the person is upright and improves when lying down. The pain is usually felt at the front or back of the head and can be accompanied by neck stiffness or nausea.

How Common Is This Condition Today?

With the use of smaller, more refined needles in modern spinal anesthesia techniques, the likelihood of significant CSF leakage has decreased. As a result, the incidence of post-lumbar puncture headaches has also dropped. Additionally, medical professionals often recommend lying flat without a pillow for 6–8 hours after the procedure to help the puncture site seal naturally and reduce the risk of headache.

What If a Headache Occurs?

In the event that a headache does develop, healthcare providers have effective treatment protocols in place. These may include increased fluid intake, intravenous hydration, caffeine administration, or in more persistent cases, an epidural blood patch. These interventions are generally safe and highly effective, so patients should not be overly concerned about this potential side effect.