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Baby Talk | Small segment of epidural patients suffers headaches

Q.I really want to have an epidural when I go into labor. I have heard that some people get a headache after having an epidural. What causes them and how are they treated?

A. Many women have epidurals, a form of spinal anesthesia, when they are in labor and have no complications. However, a small percentage of people do experience what is called a "spinal" headache after receiving spinal anesthesia. The technical name for a spinal headache is postdural puncture headache. That is an accurate description of what is believed to cause the headache.

When a patient is receiving an epidural the area where the needle will be placed to give the medication is first cleaned with a betadine solution, then the anesthesiologist injects a numbing medication (like at the dentist before you have dental work). The patient curves her back and must remain perfectly still while the doctor places the pain 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 very small the needle may actually puncture through the epidural area into the dura.

For most patients if the dura is punctured they have no problems. However, for some patients it can lead to the infamous "spinal" headache. The headache is caused by the leakage of CSF (cerebral spinal fluid) from the dura through the tiny hole created by the needle.

The patient may first experience the headache 1 to 5 days after the anesthesia was administered. They usually last for 3 to 5 days. Most people complain of pain in the front of their head, some say their whole head hurts. Some people also suffer 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 is in an upright position, the first treatment is just to keep the patient flat. The patient is encouraged to increase their fluid intake. Caffeine causes vasoconstriction, a narrowing of the vessels, which could potentially stop the leaking of fluid. Fluids with a high caffeine content are also recommended.

However the most effective treatment and the one the causes almost immediate relief of the pain is a blood patch.

A blood patch works similar to plugging a hole with a cork. When a blood patch is done, an anesthesiologist prepares the spinal area just like he or she would do to administer spinal anesthesia. When the doctor is in the right spot, a nurse prepares the area where he or she will draw 15 cc's of the patient's blood. The anesthesiologist then puts the patient's blood back into her spine. Blood clots four times faster in CSF, which is what probably causes it to create the plug. Most patients experience immediate relief from the headache after the blood patch is done.

Life is not risk free. There are many ways to manage the pain of labor and epidurals are one of those choices. Epidurals are considered to be a safe and effective tool in the management of the pain of labor.

Katie Powers, R.N., is a board-certified lactation consultant and perinatal educator at Manatee Memorial Hospital's Family BirthPlace. Contact her at katie.powers@mmhhs.com.

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