punctureheadache

A puncture headache, also known as a spontaneous intracranial hypotension headache or low-pressure headache, is a type of headache characterized by severe head pain that worsens when a person is in an upright position and improves when lying down. This positional component is a hallmark symptom. The pain is often described as dull, throbbing, or intense and can be located in the front or back of the head. Other accompanying symptoms may include neck pain or stiffness, nausea, vomiting, sensitivity to light and sound, dizziness, and tinnitus.

The underlying cause of a puncture headache is a decrease in cerebrospinal fluid (CSF) pressure within the cranial cavity. This can occur due to a spontaneous leak of CSF from the dura mater, the tough outer membrane surrounding the brain and spinal cord. While the exact reason for spontaneous leaks is not always clear, it is thought to be related to a weakness or tear in the dura. In some cases, the headache can be triggered by medical procedures such as a lumbar puncture (spinal tap) or spinal anesthesia, where CSF is intentionally withdrawn.

Diagnosis typically involves a thorough medical history and physical examination, paying close attention to the positional nature of the headache. Imaging studies like MRI or CT scans of the brain may be used to identify signs of low CSF pressure, such as sagging of the brain. In some instances, a spinal MRI can help pinpoint the location of a CSF leak. Treatment strategies aim to increase intracranial pressure and seal the leak. Conservative measures include bed rest, hydration, and caffeine. If these are insufficient, medical interventions like epidural blood patches, where the patient's own blood is injected into the epidural space to seal the leak, are often effective.