Epidural Blood Patch (EBP)
Updated: 6 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
An epidural blood patch (EBP) is a procedure in which a provider injects a small amount of your own blood into the epidural space around the spinal cord to seal a tear causing a cerebrospinal fluid leak. Such leaks cause intense spinal headaches. It is often recommended when rest or medication fails, and most people feel relief right away. cerebrospinal fluid (CSF) leak spinal headaches
What the research says
A therapeutic blood patch beat conservative care in small trials, but the evidence is thin. A Cochrane review of 9 studies (379 participants) found that a therapeutic epidural blood patch led to less post-dural puncture headache than conservative treatment (OR 0.18, 95% CI 0.04–0.76, one study) and than a sham procedure (OR 0.04, 95% CI 0.00–0.39, one study). Backache was more common after a blood patch, and the authors said there were too few participants for reliable conclusions and did not recommend prophylactic patches over other treatments (PubMed: Boonmak & Boonmak, Cochrane Database Syst Rev, 2010).
Caffeine, a common first step, has some trial support. A Cochrane review of 13 small randomized trials (479 participants) found that caffeine reduced the number of participants with post-dural puncture headache at one to two hours compared with placebo, and decreased the need for supplementary treatment. The authors cautioned that the conclusions should be interpreted carefully because of small studies and limited generalisability (PubMed: Basurto Ona et al., Cochrane Database Syst Rev, 2015).
A dural puncture can have lasting effects, and a blood patch has not been shown to prevent them. In a meta-analysis of 12 studies comparing 6,541 women with unintentional dural puncture and/or post-dural puncture headache with 1,004,510 women who had uncomplicated neuraxial procedures, the risk of headache lasting 12 months or more was higher (RR 3.95, 95% CI 2.13–7.34). Across 8 studies comparing a blood patch (3,610 women) with none (3,154 women), a blood patch was not associated with a significant reduction in long-term problems, though the authors noted limits in the data, including no information on how well it relieved the acute headache (PubMed: Mims et al., J Clin Anesth, 2022).
What Is an Epidural Blood Patch?
An epidural blood patch is a procedure in which a healthcare provider injects a small amount of your blood into the epidural space near your spinal cord to stop a CSF leak. It has two functions: it seals the puncture site or tear by forming a temporary blood clot, and it reduces low CSF pressure.
Epidural blood patch procedures are often successful at treating a spinal headache, but they don't work in some cases. An EBP is an elective procedure, which means it's optional.
When You Might Need an Epidural Blood Patch
Spinal headaches typically occur after procedures that involve the spine, though they can sometimes happen spontaneously. The pain is often intense, typically increases when you sit or stand, and gets better when you lie down.
Cause of spinal headache | Description |
Lumbar puncture | A diagnostic spinal tap that may leave a small hole in the dura mater |
Pain relief injections that accidentally puncture the dural membrane | |
Spinal surgery | Surgical procedures that result in an unintended dural tear |
Connective tissue disease | Spontaneous leaks caused by weakened tissues around the brain or spine |
Your healthcare provider may recommend an EBP if you develop a spinal headache and conservative treatment doesn't help. Conservative treatment includes bed rest, staying hydrated with IV fluids or drinking water, nonsteroidal anti-inflammatory drugs (NSAIDs), and IV or oral caffeine. You may also want an EBP if you can't rest for prolonged periods — like if you just had a baby or need to go back to work.
The Procedure Process
The epidural blood patch is a precise clinical procedure designed to provide rapid relief from the intense pain of a spinal headache.
Preparation and anesthesia
To prepare, you may need to not eat or drink anything for at least eight hours before the procedure. It is essential to tell your healthcare provider if you take blood thinners, use insulin for diabetes, have any allergies (especially to anesthesia drugs), or are pregnant.
Adults are typically not sedated for an EBP. This allows you to tell the anesthesiologist what you're feeling during the injection. Local anesthesia is often used to numb the area where the blood patch will go. Children who need an EBP may receive sedation for part of the procedure.
Step-by-step
You lie on your side or sit in a seated position, and you need to stay very still.
A provider disinfects the area of your spine where the blood patch will go, and the area where they will draw a sample of your blood — usually your forearm or wrist.
You may receive a local anesthetic, as a patch or an injection, to numb the area.
An IV catheter is placed in one of your blood vessels so a provider can collect a sample of your blood.
An anesthesiologist or radiologist inserts a needle into the epidural space near your spinal cord, sometimes using imaging guidance such as ultrasound to find the exact spot.
Right after, a provider collects your blood sample and slowly injects it into the epidural space over 30 to 60 seconds. You'll likely feel discomfort or cramping in the area, which is a normal part of the process — let the anesthesiologist know what you're feeling.
A provider covers the area with a bandage.
Recovery After the Procedure
Most people feel immediate headache relief after an epidural blood patch. A healthcare provider takes you to a recovery room to rest before you go home, and will likely tell you to avoid strenuous activity for 24 hours. After that, you can go back to your usual activities.
The clot is inside you in the epidural space, so you won't see it. It seals the leak right away and then dissolves over time — usually over days or weeks — as your body heals the underlying tear.
Success Rate and Risks
Studies show that epidural blood patches have a success rate of about 85% — about 85 out of 100 procedures result in spinal headache relief. EBPs usually provide immediate and prolonged relief, whereas conservative treatments like NSAIDs and caffeine are typically temporary. Spinal headaches can last up to two weeks, so an EBP can offer quicker relief.
A spinal headache can come back after a blood patch, but this is uncommon. A second procedure treats the headache in 90% of these cases.
The most common side effect is pain or discomfort around the injection site, which usually improves within days. Possible complications include failure of the EBP (it doesn't treat your spinal headache), worsening of your spinal headache due to accidental dural damage, and infection.
Topic | What to expect |
First patch | About 85% success — about 85 out of 100 procedures result in spinal headache relief |
If the headache returns | A second procedure treats the headache in 90% of these cases |
Common side effect | Pain or discomfort around the injection site, usually improving within days |
Possible complications | EBP doesn't work; worsening headache from accidental dural damage; infection |
When to Seek Help
Call your healthcare provider immediately if you develop signs of an infection after your epidural blood patch: skin discoloration, pain, or pus around the injection site, fever, or fatigue.
Key Takeaways
The epidural blood patch is widely regarded as the standard treatment for persistent spinal headaches caused by CSF leaks. By using your own blood to seal a dural tear, it offers an alternative to prolonged bed rest and conservative management. It is an elective procedure and it isn't always successful, but its success rate of about 85% and the potential for immediate pain relief make it a valuable option for people suffering from the debilitating effects of low CSF pressure.
Take the Next Step
If you have a severe headache after a spinal tap, epidural, or spinal surgery, talk to your healthcare provider about whether an epidural blood patch is right for you. Be sure to discuss the risks and benefits before deciding.
Related reading: Spinal Headache After a Lumbar Puncture · CSF Leak · Anesthesia Essentials · Caudal Epidural Steroid Injection
Frequently Asked Questions
1. What causes a spinal headache?
A spinal headache is caused by a leak of cerebrospinal fluid (CSF) through a hole or tear in the dura mater. It usually follows a spinal procedure like an epidural or spinal tap, but it can also develop after a dural tear from spinal surgery or injury.
2. How does the blood patch work?
The injected blood forms a temporary clot that seals the puncture site or tear in the dura, stopping the CSF leak and reducing low CSF pressure.
3. Is the procedure painful?
You will likely feel discomfort or cramping in the area as the blood is injected. A local anesthetic, given as a patch or an injection, numbs the area where the blood patch will go.
4. Why am I not sedated for the procedure?
Adults are typically not sedated so they can tell the anesthesiologist what they are feeling while the blood is injected. If you're nervous or anxious, let your provider know. Children who need an epidural blood patch may receive sedation for part of the procedure.
5. How long does the relief last?
Most people feel immediate headache relief, and an EBP usually provides prolonged relief, while conservative treatments like NSAIDs and caffeine are typically temporary. A spinal headache can come back after a blood patch, but this is uncommon.
6. What is the success rate of a blood patch?
Studies show a success rate of about 85%. If the headache comes back, a second procedure treats it in 90% of these cases.
7. What should I do after the procedure?
A healthcare provider takes you to a recovery room to rest before you go home and will likely tell you to avoid strenuous activity for 24 hours. After that, you can go back to your usual activities. Ask your provider whether you should arrange a ride home.
8. How long does the actual procedure take?
The injection itself takes 30 to 60 seconds, but the entire process, including preparation and the blood draw, takes longer.
9. What happens to the blood after it seals the leak?
The blood patch (clot) dissolves over time — usually over days or weeks — as your body heals.
10. Are there any alternatives to a blood patch?
Conservative treatments include bed rest, staying hydrated with IV fluids and/or drinking water, NSAIDs, and IV or oral caffeine. These are typically temporary, and your provider may recommend an EBP if they don't help.
References
Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev. 2010;(1):CD001791. doi:10.1002/14651858.CD001791.pub2. PMID: 20091522.
Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;(7):CD007887. doi:10.1002/14651858.CD007887.pub3. PMID: 26176166.
Mims SC, Tan HS, Sun K, et al. Long-term morbidities following unintentional dural puncture in obstetric patients: a systematic review and meta-analysis. J Clin Anesth. 2022;79:110787. doi:10.1016/j.jclinane.2022.110787. PMID: 35358942.
Cleveland Clinic. Epidural blood patch. Cleveland Clinic Health Library. Medically reviewed; last updated July 8, 2024. https://my.clevelandclinic.org/health/procedures/epidural-blood-patch
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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