Low-pressure headaches result when cerebrospinal fluid is removed during a spinal tap (lumbar puncture) or leaks out because of a cyst or tear in one of the layers of tissues that cover the spinal cord (meninges). Loss of this fluid, which flows around and cushions the brain, reduces pressure around the brain.

Most commonly, low-pressure headaches occur after

• A spinal tap (lumbar puncture)

A low-pressure headache occurs in about 10% of people who have had a spinal tap, usually hours to a day or two afterward. In a spinal tap (see Symptoms and Diagnosis of Brain, Spinal Cord, and Nerve Disorders: How a Spinal Tap Is Done ), doctors insert a needle between two vertebrae in the lower back, and withdraw a sample of cerebrospinal fluid from the spinal canal. The cerebrospinal fluid, which flows through a channel between the layers of tissues (meninges) that cover the brain and spinal cord, helps cushion and support the brain. After a spinal tap, cerebrospinal fluid sometimes continues to leak out of the hole made by the needle. If enough fluid leaks out after the spinal tap, the amount of fluid around the brain decreases, and the brain may sag downward, stretching the surrounding tissues and nerves. This stretching results in a headache.

Low-pressure headaches may also occur when other problems cause cerebrospinal fluid to leak out:

• A cyst in or near the meninges bursts. Cysts sometimes burst when people cough or sneeze.
• The meninges are torn during an injury, particularly when the head or face is injured.

Low-pressure headaches are intense. They occur when people sit or stand and may be relieved by lying flat. People usually also have a stiff, painful neck and may vomit.

Diagnosis

Doctors base the diagnosis on the symptoms and the situation. If people have had a spinal tap, the diagnosis is usually obvious, and testing is rarely needed. If they have not had a spinal tap, imaging tests, such as magnetic resonance imaging (MRI), may be done.

Treatment

If people have a headache after a spinal tap, they are given pain relievers (analgesics). Lying flat as much as possible helps minimize pain. They are given fluids and caffeine, which increases the production of cerebrospinal fluid. Fluids are given by mouth or, if people are very dehydrated, intravenously.

If the headache persists after such treatment, doctors may inject a small amount of the person's blood into the space between the spine and the meninges in the lower back. This procedure, called an epidural blood patch, slows the leakage of cerebrospinal fluid, regardless of where the leak is.

Surgery to repair a leak is rarely required.

Last full review/revision May 2012 by Stephen D. Silberstein, MD