spinal fluid leak

  : : I have read your archives on spinal headaches, but have additional questions.  I got a spinal headache 3 months ago following a prolotherapy treatment.  After 3 days of severe headache, I received a blood patch, rested horizontal for about 15 minutes, and sent home.  I did not lay down after this.  The headache dissapeared completely for about 10 hours.  Then, a smaller headache returned which I have had since.  I have had 2 more blood patches since, and in each case, felt worse after.  I had a lumbar MRI after the second patch.  The report indicated no vissible leakage.  I feel it is still there, but very small.  In all of these blood patches, I was sent home lying down in our minivan.  The ride felt qiite bumpy in this position and even the braking/acceleration forces were felt.  Would this have destroyed any possible success of the patch?  Also, I wonder if at this point a blood patch may be ineffective with the greater fluid pressure, since the headache is much smaller.  Maybe the small hole acts like a nozzle now, blowing away the patch.  At this point, does extended bed rest really work?  If so, how long, can you move in bed, and can you get up to go to the bathroom and shower?  I also read in your archive about draining fluid 3-5 days with bed rest, is this the next step, it sounds risky.  I am willing to do nothing and let nature take its course, however, I have the feeling this condition may become chronic?  What are your comments about a surgical patch?  
  :

[CCF Neuro[P] MD RPS]

_

Dear Rick:
Sounds like you stil have a spinal leak headache.  The caffeine will help the headache somewhat but if the primary problem is not taken care of then it will have little effect.  I would recommend that you lie flat for several hours, minimum for 3-4 hours and if needed then more.  If the person doing the patching is good then the shorter time is okay but if this is a person who hasn't done alot, then I would error on the side of longer.  The patches should not make the pain worse for that long, I am not sure what might be causing the pain.  The procedure will give you a sore back but that should resolve in a couple of days.  No, extended bed rest will not cure a leaky CSF, only the stopping of the leak will cure this headache.  No, there are only a few medications that can be given by IV to help CSF pressure, one is mannitol.  High CSF pressure needs to be relieved by draining the CSF directly if the CSF pressure is high.  Long term increased pressure can damage your retina and optic nerve.  
Good luck.
Sincerely,
CCF Neuro[P] MD