In plain words
A post-dural puncture headache is a headache caused by fluid leaking from the spinal canal after a needle has passed through the membrane around the spinal cord. The leak lowers pressure in the . It is most common in the first few days after an or spinal anesthetic. The pain is usually felt at the back of the head and may spread to the neck. Its signature is a change with position: it is worse upright and better lying flat. Some mothers also notice neck stiffness, nausea, or changes in hearing or vision. It is not the same as an ordinary or . Because other causes of a headache after birth are rare and serious, any new headache after an epidural needs prompt assessment by a clinician.
The deeper version
Post-dural puncture headache is defined in the International Classification of Headache Disorders, 3rd edition (International Headache Society, 2018) as a headache occurring within 5 days of a dural puncture, attributed to low cerebrospinal fluid pressure from a leak, that resolves spontaneously or after treatment. Incidence is high after accidental dural puncture with a large-bore needle and low after epidural placement with a small or atraumatic needle. Pathophysiology is CSF leak with intracranial hypotension, which produces traction on pain-sensitive meningeal structures. The differential includes subdural hematoma, , and pneumocephalus, which must be excluded when symptoms are atypical or persistent. The key controversy is the balance among conservative care, , and needle design at delivery.
Where it comes up
- Headaches after birthPostpartum: Your Body
- Headaches and migrainesPregnancy: Your Body
- Pain options: from breathing to epiduralGetting Ready for Birth
- Back, neck, and shoulder pain from feeding and carryingPostpartum: Your Body
What mothers here say about post-dural puncture headache
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Sources
- International Headache Society, Headache Classification Committee — International Classification of Headache Disorders, 3rd edition (2018)
- American Society of Anesthesiologists — Practice Guidelines for Obstetric Anesthesia (2016)