Free checker · After spinal or epidural · By an anesthesiologist
Headache after your spinal or epidural? Check the pattern.
The "spinal headache" has a signature — and a genuinely effective fix. Answer four questions to see whether yours fits, what to do tonight, and when to call the anesthesia team about a blood patch.
🚨 Skip the checker — get urgent care NOW if you have:
the worst headache of your life (sudden, thunderclap) · fever with a stiff neck · confusion or drowsiness · weakness, vision loss or trouble speaking · a seizure. These aren't spinal-headache questions.
Quick answer
A spinal headache (PDPH) starts 1–5 days after a spinal or epidural and has one signature: much worse sitting or standing, dramatically better lying flat, often with neck stiffness. Affects roughly 1 in 100 spinals with modern needles (more after an accidental epidural puncture). Treatment: lie flat when it hurts, fluids, simple painkillers, and caffeine — genuinely. Severe or persistent? Call the hospital's anesthesia team about an epidural blood patch — the definitive fix, often working within hours. Same-position-all-the-time headaches, fever, weakness or confusion are different problems — get seen today.
Your headache:
Why it happens — and why the fix works so well
Your brain floats in fluid. The spinal needle leaves a pinhole in the membrane that holds that fluid; if it leaks faster than your body replaces it, the cushioning pressure drops and pain-sensitive structures get stretched whenever you're upright — which is why lying flat switches the headache off. Modern "pencil-point" needles have made this uncommon after spinals (~1 in 100); it's more likely after an accidental puncture during an epidural (~1 in 100 epidurals, of which about half get the headache).
The epidural blood patch works because your own blood clots over the pinhole — sealing the leak and restoring pressure, often within hours. It's a 20-minute procedure done by an anesthesiologist, and it's the reason nobody should spend two weeks flat on their back "waiting it out." If your headache is severe, call the hospital's anesthesia team and say the words "possible post-dural puncture headache." Curious how the needle placement works in the first place? See epidural vs spinal.
Frequently asked questions
What is a spinal headache (post-dural puncture headache, PDPH)?
The spinal needle (or occasionally an epidural needle) makes a tiny hole in the membrane holding the fluid around your spinal cord. If that hole leaks, fluid pressure around the brain drops and you get a very characteristic headache: much worse sitting or standing, dramatically better lying flat, often with neck stiffness, and sometimes ear or hearing symptoms. It typically starts 1–5 days after the procedure.
How do I know if my headache is a spinal headache and not something else?
The postural pattern is the signature: markedly worse upright, clearly better within minutes of lying flat. A headache that's the same in every position, or the 'worst headache of your life,' or one with fever, confusion, weakness, vision loss or seizures is NOT a typical PDPH — those need urgent medical review the same day.
How is a spinal headache treated?
Mild ones: lie flat when it hurts, drink well, use regular simple painkillers (paracetamol/ibuprofen if allowed), and caffeine genuinely helps — a couple of strong coffees a day is a real treatment here. Many settle within a week. Severe or persistent ones have a very effective fix: the epidural blood patch — a small amount of your own blood injected at the leak site, which seals it. Relief is often rapid, and most patients need only one.
What is an epidural blood patch and does it work?
An anesthesiologist draws a little of your blood and injects it into the epidural space at the level of the original puncture. The blood clots over the leak and pressure restores — many people feel better within hours. Success rates are high (most patients get major or complete relief; a second patch is occasionally needed). It's the definitive treatment for a bad PDPH, so don't suffer for weeks — call the hospital's anesthesia team.
Who do I call about a headache after my spinal or epidural?
The hospital where you had the procedure — ask for the anesthesia/pain team; maternity units have this pathway ready-made for post-epidural mothers. Call the same day if the headache is severe, stops you caring for your baby or yourself, or isn't controlled by lying flat and simple painkillers. Go to emergency care for fever with a stiff neck, confusion, weakness, vision changes or seizure.