Possible cause of Migraine?

[Haileysmomsc]

I had my daughter December of 2006. Had some back pains and headaches but they started getting worse the end of last year. Finally seen a neuroligist and had a brain MRI, with and w/o contrast, which came back negative. My migraines are getting worse. I am currently taking 50 mgs of Amitriptyline, 100 mgs of Topamax, 60 mgs of Inderal, 200 mgs of B2 vitamins, Treximet and Tramadol when needed for headache. I had 2 epidurals when I was in labor, the first one didn't take. I asked my neurologist if that epidural could have caused some kind of nerve damage that could be causing these headaches now. He said that was a long shot. Is it? What kind of test can they do to tell? I suffer from 3-5 headaches a week! Please help! Any info would be greatly appreciated. Thank you!

[selmaS]

. Why and how often do headaches occur after spinal or epidural anesthesia?

A. First, a brief anatomy lesson! The average sized adult human has roughly 150ml (a little less than 8 oz or 1 cup) of a clear watery fluid, called cerebrospinal fluid (CSF) in the central nervous system, surrounding the spinal cord and brain. One of the functions of the CSF is to provide a protective layer, essentially to act as a cushion to shield the brain from the hard bony skull and to provide a soft environment for the blood vessels to supply and drain blood from the brain. There is a thin membrane surrounding the brain and spinal cord called the "dura". When there is loss of CSF for whatever reason, usually as a result of a hole in the dura, the brain tends to sag, due to loss of this protective fluid cushion. This brain sagging causes stretching in the connective tissues in the cranium, this stretching is sensed as pain, and hence the headache. Also, the loss of some CSF causes blood vessels in the brain to dilate, which can also be perceived as a painful sensation. The technical term for this kind of headache, known commonly as "spinal headache", is post-dural puncture headache, or PDPH.

When spinal anesthesia is done, a very tiny needle is placed through the dura, in the lower back, to inject the spinal medicine. Spinal needles are very small, and the hole made in the dura is also small, thus some, but very little CSF leaks out. In a few cases, (approximately 1% of the time) this leak of CSF is enough to cause a PDPH. In contrast, when an epidural is done, the dura is not punctured intentionally, as the catheter and injected medicine lies entirely outside of the dura, in the epidural space. However, sometimes, even in experienced hands, the epidural needle goes a bit too far and a hole is made in the dura. Anesthesiologists call this a "wet tap". There is a more significant leak of CSF in this case, because the epidural needle is much larger than a spinal needle. Statistics show that this happens in about 1% of cases. When a wet tap does occur with an epidural needle, the incidence of headache goes way up to about 50-70%. (In the absence of a wet tap, a PDPH is extremely rare.) In general, women tend to be more susceptible to spinal headaches, and age is important also, with younger people (e.g., less than age 40-50 or so) more likely than older to suffer this kind of headache. Hence, pregnant women are in the group at highest likelihood of experiencing this complication. So to summarize those statistics, a "wet tap" will occur in about 1% of cases, and slightly more than half of those will go on to get a headache - so the overall chance of a spinal headache after epidural anesthesia is about 1 out of 200.

To check for a spinal leak u need to get a CINE MRI....it needs a specialist to read it....this will also look for and detect a blockage of the flow...this is sometimes called a flow study.

I hope this answered ur quesstion, but a full check up is needed to rule everything out.
please keep in touch with ur updates.
Good luck
Godspeed
"selma"