Babytalk | ‘Epidural ‘headaches.’ A pain-free baby delivery comes with risks
Many women have epidurals, a form of spinal anesthesia, when they are in labor. A small percentage experience what is called a “spinal” headache after delivery.
The technical name for a spinal headache is postdural puncture headache. The term is an accurate description of the cause of the headache.
When a patient is receiving an epidural, the area where the needle will be placed to give the medication is first cleaned. A betadine solution is rubbed over the area. The anesthesiologist injects a numbing medication, so the insertion of the needle will not be painful.
The patient curves her back and must remain perfectly still while the anesthesiologist or nurse anesthetist places the medication in the epidural space of the spine. “Epi” means around, “dural” refers to the dura area of the spine.
If the patient moves or if the space is small, the needle may puncture through the epidural area into the dura.
For many patients, if the dura is punctured they have no problem. For some the puncture into the dura creates the infamous “spinal” headache. The headache is caused by the leakage of CSF (cerebral spinal fluid) from the dura through the hole created by the needle.
The patient may first experience the headache from one to five days after the anesthesia was administered. The headache usually lasts for three to five days. Most people complain of pain in the front of their head. Some have pain throughout their whole head. Some complain from visual disturbances, a stiff neck, nausea and vomiting.
Treatment usually starts with treating the symptoms. Since the headache is most pronounced when the patient in in an upright position, the first thing we advise is to lay flat. The patient is encouraged to increase fluid intake. Caffeine is encouraged because it causes vasoconstriction, a narrowing of the blood vessels, which may also stop the leaking of fluid.
If none of those things work, a blood patch may have to be done.
A blood patch works similar to plugging a hole with a cork. When a blood patch is done, the anesthesiologist or nurse anesthetist will prepare the area just like it was done for the initial administration of spinal anesthesia. The area is cleansed and prepared.
Blood is drawn from any good vein that can provide around 15 cc’s of blood. The anesthesiologist or anesthetist will then inject the blood into the cleansed area of the back. Blood clots four times faster in CSF which is why it is effective in creating a plug. Most patients experience immediate relief from the headache after the blood patch is done.
Life is not risk free. Epidurals are considered to be a safe and effective tool in the management of the pain of labor. There are many ways to manage the pain of labor and epidurals are one of those choices.
Katie Powers, R.N., is a board-certified lactation consultant and perinatal educator at Manatee Memorial Hospital’s Family BirthPlace. Her column appears every other week in Healthy Living in the Bradenton Herald. Contact her at katie.powers@mmhhs.com.