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Post Hole Bit
The Facts About Post Dural Puncture Headaches (PDPH)
The dura mater is the term for the spinal cord lining, and a hole in it typically results from something like a myelogram or a lumbar puncture (spinal tap). Or possibly when the patient is having an arizona pain management epidural injection or a spinal cord stimulator trial the dural sac (spinal cord) is punctured which is a normal complication but may not seal up like it should. The body replenishes its cerebrospinal fluid every 4 hours, so if a bit of CSF leaks out after one of these procedures and the hole seals up as it usually does rest of the CSF will be replaced very soon.
Usually if a patient undergoes one of these procedures, any residual hole from the needle used will seal up on its own very quickly. The body knows it's not supposed to have a hole in the dural sac, so it seals it. If the hole persists, cerebrospinal fluid will leak out into the epidural space. This may create a situation where structures in the skull gradually shift downwards from gravity where the liquid is seeping out. Since the cerebrospinal fluid runs from the brain all the way down the spinal column within the spinal cord, if it's draining out, the skull structures shifting downwards will stretch sensitive fascial and ligament structures. Dilation occurs in the cerebral vessels, and a very large headache occurs.
The term for this is a post dural puncture headache. These headaches are very very painful while sitting upright or standing and tend to dissipate when laying down. Additional symptoms including pain across the upper back, neck stiffness, and light sensitivity (photophobia).
Treatment for the post dural puncture headache includes laying down, which reduces symptoms and often decreases gravity on the hole so that it may spontaneously close. Hydration and pain medication may help to facilitate extra CSF production. Caffeine may close down the vasodilated vessels in the head and decrease the headache symptoms.
If these treatment options don't work, an epidural blood patch may do the trick. If you have had a procedure at an AZ pain center where the dural sac was potentially "poked" either intentionally or unintentionally and the symptoms of a post-dural headache are persisting, try laying down and see if it dissipates. Then call your doctor for further instructions for treatment. It's a typical complication and often does get taken care of by one of the mentioned treatments.
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