Chronic Daily Headache Condition After Lumbar Puncture

[JLC081493]

In 1/05 I had a lumbar puncture to rule out M.S.  This test was negative; however, I had a severe reaction to the procedure and was hospitalized with a severe spinal headache.  An anesthesiologist subsequently placed an epidural blood patch on my spinal cord to seal a leak.  While this lessened the severity of my headache and has allowed me to function better, four mos. after these procedures I am still plagued with headaches 24/7.  My Neurologist, who specializes in headaches, did another MRI of my spine to check for a leak, which was "essentially negative". We have tried several meds and combinations. Amitriptyline proved to be somewhat effective after 4 wks of therapy, but had too many side effects to tolerate an increase.  While my headaches lessened from 24/7, I still had them on and off daily, with a few hours of relief at times.  We switched to Nortriptyline 25 mg hs and added Zanaflex 4 mg hs with less side effects. I take up to 8 Midrin daily alternating with Tramadol to manage the pain. The headaches worsen with activity. My Dr. said my spinal headache resulted in a type of transformed chronic daily headache process.  Why would this occur after this procedure?  How can it be resolved so I can function without daily 24/7 headaches? The pain is more concentrated at the base of my skull and is constant. My Dr. said this occurs more in young women, which I am, and that it is very rare . . . not much is known about why it happens.  I really need to understand this better and need some hope to correct it! Thank you so much for this forum and your assistance.

[CCF-Neuro-M.D.-PW]

For reasons we do not entirely understand, any type of headache can evolve into a 'chronic daily headache', that can run on its own, independent of what caused it in the first place



One common confounding problem is the contribution of medication to the headache - too much (even what many people do not consider too much) can make the headache worse in the long run

for instance taking 8 midrin daily on a chronic basis would cause a rebound worsening of the headache, necessitating further use and a viscious cycle. Stopping the frequent use of analgesics for acute attacks will return the headache to an episodic form (usually decreasing by 10% a week). Nonsteroidal analgesics like Naproxen are least likely to cause overuse headache and can be used instead. The right preventative medication should also be used to prevent episodic headaches, but does not work if medication overuse is ongoing.



Of course, hopefully any persistent spinal fluid leak is not present - I cannot confirm this for you or not, as I do not have the details of the tests done to confirm this. MRI flow studies, CT myleograms (with dye) and nuclear medicine scans can all be used to investigate this

Good luck

[brannodz]

I have a similar condition (daily persistent headache).  After a lot of trial and error, I tried depakote IV and nadalol and am continuing tweaking the dosings.  



If you try the above, titrate up your doses rather than doing them like I did with the infusion (depakote has pill forms as well).  In addition, drinking anything with caffeine helps.



I feel much MUCH better, but after about 7 months, I still have a somewhat "dizy" or "off feeling," and that a headache could start at any moment of the day.  I'm thinking of going off the meds and trying just a new med, amitriptyline (i'm uncertain of the spelling).  Please email me, or respond if you want to keep talking about this because there just isn't much info. out there for people that suffer.  Also, if you try something that works, please post or email.



David



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[RuthH]

Hi, I had a lumbar puncture several years ago & had horrid headaches after; for about 2 weeks. What the doctor ordering the test, the techs preforming the tests & anyone else connected with the testing neglected to give me the following info. I had to call back & talk with a lab tech to find out what was happening.



After a puncture, your spinal area has to SCAR over; it doesn't clot as your skin does after blood work. It takes at least 2 weeks for it to scar over. Until that time, everytime you sit or stand, the spinal fluid leaves your head & drains down & leaks out where the needle was inserted for the procedure. It's that vaccum effect that causes the headaches; the spinal fluid is draining away from your brain.



I did everything either laying on my back in the floor, sofa, or in bed including eating. Of course, I would turn to the side to eat, but I didn't sit up. The only time I was up was to use the bathroom or for a very quick shower. Other than that, I stayed as flat as possible. This helped wonderfully!!!



Give it a try!! Good Luck, Ruth H in WV

[JLC081493]

Thanks so much for your time and review of my case.  This forum is such a blessing to people needing additional medical direction and expertise.  My Neurologist is scheduling a second epidural blood patch for this week, as he believes I still have a low pressure headache from a persistent spinal fluid leak. The headaches seem unresponsive to preventative medications.  In addition, I have tinnitus in both ears, which developed the day of the initial spinal tap and still has not resolved.  Is this common with a spinal fluid leak? How can we be sure to identify the original site of the puncture to ensure success of the second patch?  (The Neurologist who did the original LP is not the one who will do the patch.  Either an anesthesiologit or a radiologist will do the 2nd patch). Is there anything I can do to ensure success of the second patch?  Thanks again.