Spinal Headache After a Lumbar Puncture: Causes and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
TL;DR: A spinal headache (also called a post-dural puncture headache) is a fairly common complication of a spinal tap (lumbar puncture) or spinal anesthesia. When spinal fluid leaks through the tiny puncture hole, the drop in fluid pressure around the brain and spinal cord causes the headache. Its defining feature is pain that gets worse when you sit or stand and decreases or goes away when you lie down, usually starting 48 to 72 hours after the procedure. Most spinal headaches resolve on their own, and providers first recommend bed rest, fluids, caffeine, and oral pain relievers. If the headache hasn't improved within 24 hours, an epidural blood patch is the usual treatment.
Quick Answer: What You Need to Know About Spinal Headaches
Who is this for? Anyone who has recently had a spinal tap (lumbar puncture), spinal anesthesia, or epidural anesthesia and is now experiencing a new headache.
What it is: A headache caused by spinal fluid leaking through a puncture hole in the dura mater — the membrane that surrounds the spinal cord.
How it starts: Typically appears within 48 to 72 hours after a spinal tap or spinal anesthesia; occasionally after epidural anesthesia if the membrane is unintentionally punctured.
The telltale sign: Dull, throbbing pain that gets worse when you sit up or stand and decreases or goes away when you lie down.
How common/serious: A fairly common complication; most resolve on their own, though severe headaches lasting 24 hours or more may need treatment.
Six risk factors: Ages 18–30, female, pregnant, history of frequent headaches, larger needles or multiple punctures, small body mass.
When to call your provider: For any headache after a spinal tap or spinal anesthesia — especially if it worsens when sitting or standing.
How it's treated: First conservatively (bed rest, fluids, caffeine, pain relievers); then, if no improvement within 24 hours, an epidural blood patch that seals the leak.
What Is a Spinal Headache?
Spinal headaches are a fairly common complication in people who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the dura mater — the membrane that surrounds the spinal cord and, in the lower spine, the lumbar and sacral nerve roots.
During a spinal tap, a sample of cerebrospinal fluid (the fluid that cushions the brain and spinal cord) is withdrawn from the spinal canal. During spinal anesthesia, medication is injected into the spinal canal to numb the nerves in the lower half of the body.
If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache. These headaches are also known as post-dural puncture headaches. The reassuring news: most resolve on their own with no treatment. Severe spinal headaches lasting 24 hours or more may need treatment.
What Does a Spinal Headache Feel Like?
The defining symptom is unmistakable once you know what to look for:
Positional pain (the hallmark): Pain that typically gets worse when you sit up or stand and decreases or goes away when you lie down.
Pain quality: Dull, throbbing pain that varies in intensity from mild to very severe.
Spinal headaches are also often accompanied by a range of other symptoms:
Dizziness — a feeling of lightheadedness or unsteadiness.
Ringing in the ears (tinnitus) — buzzing or ringing sounds with no external source.
Hearing loss — reduced hearing during the episode.
Blurred or double vision — changes in visual clarity.
Sensitivity to light (photophobia) — discomfort in bright light.
Nausea and vomiting — stomach upset accompanying the headache.
Neck pain or stiffness — soreness or rigidity in the neck.
Seizures — a rare but possible accompanying symptom.
When Should You See a Doctor?
Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up or stand.
That positional pattern is the key detail your provider needs to hear, because it points directly to a post-dural puncture headache rather than other causes. Be sure to mention any recent procedures, particularly a spinal tap or spinal anesthesia.
What Causes Spinal Headaches?
Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the dura mater — the membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, and that pressure drop is what leads to the headache.
When does it typically appear? Within 48 to 72 hours after a spinal tap or spinal anesthesia.
What is the mechanism? Spinal fluid leaks through the puncture hole, lowering pressure on the brain and spinal cord.
Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured during the procedure.
Who Is at Risk?
Six factors raise the odds of developing a spinal headache after a spinal procedure:
Being between the ages of 18 and 30 — younger adults are more prone.
Being female — women have higher risk.
Being pregnant — pregnancy increases risk.
Having a history of frequent headaches — prior headache patterns raise susceptibility.
Undergoing procedures involving larger needles or multiple punctures — more or larger puncture holes increase leak risk.
Having a small body mass — smaller body size is associated with higher risk.
How Are Spinal Headaches Diagnosed?
Diagnosis of a spinal headache is straightforward, because the history usually tells the story:
Medical history and symptom questions: Your provider asks about your headache; be sure to mention any recent procedures, particularly a spinal tap or spinal anesthesia.
Physical exam: A standard exam to assess the headache and rule out other causes.
MRI (magnetic resonance imaging) — sometimes: Recommended to rule out other causes of your headache; a magnetic field and radio waves create cross-sectional images of the brain.
How Are Spinal Headaches Treated?
Treatment for spinal headaches begins conservatively — and for most people, that is all that is ever needed:
Bed rest — lying down relieves the positional pain while the puncture heals.
Drinking plenty of fluids — supports the body's recovery.
Consuming caffeine — helps relieve the low-pressure headache.
Oral pain relievers — manages pain during recovery.
The epidural blood patch: treatment when conservative care falls short
If your headache hasn't improved within 24 hours, your provider might suggest an epidural blood patch:
Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache.
This is the usual treatment for persistent spinal headaches that don't resolve on their own.
Preparing for Your Appointment
If you've recently had a spinal procedure and develop a headache that lasts 24 hours or longer, your provider can help you determine the seriousness of your condition.
What you can do: Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Make a list of all medications, vitamins, and supplements you're taking. Take a family member or friend along if possible. Write down questions to ask your provider.
Questions you might ask your provider:
What is likely causing my symptoms or condition?
Are there other causes?
What tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What alternatives are there to the approach you're suggesting?
I have other health conditions — how can I best manage them together?
Are there any restrictions I need to follow?
Should I see a specialist?
Are there brochures or other printed material I can take? What websites do you recommend?
What your provider will ask you:
When did your headache begin?
Does your headache worsen when you sit, stand, or lie down?
Do you have a history of headaches? What type?
Conclusion
A spinal headache is an uncomfortable but largely self-limiting complication of spinal taps and spinal anesthesia. Its hallmark — pain that worsens upright and eases when lying down, typically beginning two to three days after the procedure — makes it one of the easier headaches for providers to recognize. Most people recover with nothing more than rest, fluids, caffeine, and over-the-counter pain relief. For those whose pain persists beyond 24 hours, the epidural blood patch offers a reliable, targeted fix: your own blood seals the leak, restores normal spinal fluid pressure, and relieves the headache. If you have recently had a spinal procedure and develop a new headache, do not wait it out in silence — a quick conversation with your provider is all it takes to put the right plan in place.
Experiencing a new headache after a spinal procedure? Talk to your provider today, and explore our related headache guides below to understand your symptoms better.
FAQ
What is a spinal headache?
A spinal headache — also known as a post-dural puncture headache — is a headache caused by leakage of spinal fluid through a puncture hole in the dura mater, the membrane that surrounds the spinal cord. It is a fairly common complication of spinal taps (lumbar punctures) and spinal anesthesia.
Why do spinal headaches hurt more when I sit up or stand?
The leak lowers the pressure exerted by spinal fluid on the brain and spinal cord. When you sit or stand, that pressure drop worsens, intensifying the pain; lying down relieves it. This positional pattern — worse upright, better flat — is the defining feature of a spinal headache.
When do spinal headaches start after a procedure?
Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia.
Who is most likely to get a spinal headache?
Six risk factors raise the odds: being between the ages of 18 and 30, being female, being pregnant, having a history of frequent headaches, undergoing procedures involving larger needles or multiple punctures, and having a small body mass.
How long do spinal headaches last?
Most spinal headaches resolve on their own with no treatment. However, severe spinal headaches lasting 24 hours or more may need treatment.
Can epidural anesthesia cause a spinal headache too?
Yes, sometimes. Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured during the procedure.
What are the first-line treatments for a spinal headache?
Treatment begins conservatively: bed rest, drinking plenty of fluids, consuming caffeine, and taking oral pain relievers.
What is an epidural blood patch?
An epidural blood patch is the usual treatment for persistent spinal headaches that don't resolve on their own. A small amount of your own blood is injected into the space over the puncture hole, where it often forms a clot that seals the hole, restores normal pressure in the spinal fluid, and relieves the headache. It is typically offered if the headache hasn't improved within 24 hours.
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References
Health information, not medical advice. This article is for general education and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your own health, and seek emergency care for urgent symptoms.
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