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Epidural for Childbirth and Migraine: What is the Connection?

The use of an epidural for anesthesia during delivery is used by over 50% of women in labor in the United States. The area (low back) is prepped and a needle is injected in between the vertebrae and then the anesthetic medication is delivered by a catheter placed between the epidural and spinal cord. If the needle is pushed in too far, it can pierce the membrane or “dura” that forms the spinal sac containing cerebrospinal fluid (CSF) surrounding the spinal cord. In this case, a small leak of CSF occurs into the epidural space. This causes a “low pressure” headache. However, this complication is uncommon and occurs < 1% of the time when an epidural is performed. This headache is severe enough that is can present like a migraine but is very positional in nature; sitting up or standing exacerbates the headache since the CSF would then move away from the brain due to gravity. Lying down would bring more of the CSF back around the brain, thereby relieving the headache to a degree.

Women with a history of migraine may be more prone to an epidural headache as they are more sensitive to changes in their environment including any change in cerebrospinal fluid pressure. Women with a history of migraine may also experience worsening of their migraines after delivery due to the marked drop in estrogen after delivery. To differentiate if a post-partum headache is migraine or an epidural headache, look for the following:

  1. If the headache occurs within 18 hours of the epidural and if the headache is better lying down and much worse when sitting or standing, it is probably an epidural headache and most likely is due to a CSF leak from the epidural needle piercing the dura surrounding the spinal cord.
  2. If the headache is not positional and hurts even when lying down and has associated symptoms of migraine such as nausea, vomiting, sensitivity to light and noise, then think migraine.

Treatment for an epidural headache can be symptomatic such as lying flat, drinking lots of fluids including caffeine, and bed rest. It usually resolves within 4-5 days. The leak may resolve spontaneously; if not, then an epidural blood patch can be very effective. A small amount of blood can be taken out of a woman’s vein in her arm and then injected in the area of the leak where the epidural needle had been injected. This blood patch treatment is effective over 85% of the time and usually relieves the headache in a few hours. On occasion, it may need to be repeated.

Treatment for migraine exacerbation after delivery can include most traditional migraine medications including Sumatriptan (Imitrex) injection, Ketorolac (Toradol) injection, Odansetron (Zofran) injection, and oral triptan medications. For some triptans, it may be recommended for the woman to pump and discard her breast milk for several hours after ingestion; however, Sumatriptan has been determined to be compatible with breast-feeding as are most anti-inflammatory medications such as Ibuprofen and Naproxen.

In summary, epidural anesthesia is common for women in labor and causes a severe headache less than 1% of the time. This type of headache usually resolves in 4-5 days and if severe, can be effectively treated with an epidural blood patch.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Angiestl
    5 years ago

    Fwestivus, I gotta say, I’m so so sorry they wouldn’t do a blood patch!! I suffer from a condition where I have too much CSF, therefor have headaches caused by that among other things, and out of the four or five lumbar punctures I’ve had, the most horrible was by an overconfident neurologist that refused to get up, because she’d never had a spine she couldn’t tap. Even though if warned her that my first LP was a terrible experience, and she’d been trying for 45 minutes to an hour and a half before she FINALLY hit fluid. But who knows at what point she made the hole that caused the leak. I spent a week not able to get food for myself unless it didn’t have to be cooked or microwaved or anything more than pulled out of a package and brought back to what ever flat surface I was hanging out on. Then the neuro’s office argued that since I’d taken Tylenol for the pain in my poor vertebrae, from where she’d stabbed and scraped and who knows what else, that I didn’t have a low pressure headache, but a rebound headache. I almost lost it right then, because they were trying to blame everything off onto rebound headaches even though back then in the good old days, I only took pain meds about once or twice a week, compared to 4 times a day now. And back then they were OTC more often than not. But those daily headaches, that I didn’t take ANYTHING for, were caused by those pesky one or two doses of pain meds a week. When I asked if all rebound headaches were positional like mine was, she got all flustered and didn’t know what to say. And I was asking for a blood patch, not meds, when they’d pegged me as a drug seeker. Sorry, that’s what I have a pain management dr for, since he has a brain AND common sense to be able to know that if I’m asking for a blood patch, it’s probably because I need one. With my condition, there’s tes when a lumbar puncture is the only way to relieve the pressure on the brain, there for the pain. So it’s really dumb of the ER docs to get all upset at my friends when they come to the ER saying I have a pain level of 15 and I need an LP. That’s all I want. No meds, no narcotics, just a giant needle in my back and a bandage over it. We’ll call it good!! Luckily I’ve only gotten that bad a couple times and my meds to get rid of the pressure kicked in quickly. So those pesky epidurals, whether it’s for childbirth, back pain relief with steroids, or to draw off some CSF, it’s a tricky game that should only be played by the most experienced and the training shouldn’t be left to be done on first time patients! Really horrible experience!

  • Denise
    5 years ago

    I have had headaches and migraines since I was 10. Never really thought about them being frequently just took motrin when I had one. But after my son was born by C-Section at the Naval Hospital where everyone is a guinea pig and I was young and didnt understand the nurse anesthetist was a student and trying to do a spinal block (or I would have said NO SHE CANT PRACTICE ON ME. and IM a NURSE) she tried 5 pokes couldnt get it in so the Anesthesiologist took over and did the spinal block 1 stick. So the next day I woke up with a horrible migraine with nausea and flashing lights. Of course they said it will go away just lay flat in a dark room and drink lots of fluids preferably with caffeinated ones because the had already taken my IV out and here is your baby. Needless to say when I left at the minimum amount of hours you have to stay after a C-Section 48 hrs it didnt get better and I couldnt take of my son or daughter without sitting UP thank god my hubby was home. After a week my hubby drove me back to get my staples out and he said please fix her headache/migraine all she does is cry from the pain. So I did the Epiduric blood patch and finally had relief but after that I started having regular migraines 2-3 times a week. Was sent to a Neurologist had a MRI found out I have Chiari 1 Malformation and the leaking out of my CSF just made it worse. So now I have migraines 3-4 or more migraines a week take 3 preventatives headache meds and have 2 different meds to take at the onst of a migraine or an aura. Also have acupuncture and Botox and was told I could have surgery and they would either take out my C1 vertebrae or put a mesh in told hold up my cerebellum tonsils. So Im hoping to skip the surgery or wait until my hubby retires and we live by family so we have help in case something goes wrong since they are messing around right at the beginning of the spine and the brain stem. After having finally found out why I have so many migraines it took years I 34 before they diagnosed me I had my son at 26. Im now 38 and wish I asked the magical words How many of these have you done aready? Im also more medically knowledgeable since I went to nursing school after having my son. My sister is a nurse to so she was always trying to explain stuff over the phone. But Chiari is hereditary so I was most likely BORN with it but lots of people are and have no side effects until something like this happens. My daughter has chiari 1 but her herniation is small at 5mm it just made it to be diagnosed as Chiari 1. My son has migraines but hasnt had a MRI yet. MY daughter 17 and my son is 12. They did my daughters first MRI for diagnosis when she was 16 due to Chronic migraine so bad that she is homebound from school and takes 2 preventative meds and has 2 fast acting meds for when they hit and get botox and acupuncture. I am going to get a MRI for my son before my husband retires from Active duty military and we move from a a very big east coast town to where I grew up in a very small town in Kansas. I advise anyone who has someone i.e. DR. or the like that wants to do anything that could cause loss of CSF why? How many of these procedures have you done, only you are performing the procedure?, what is the percentage or degree of improvement if I have this procedure?, Make a list write it down, take it with you. Also No one gets to jab around in my bod or my hubby, and kids including for simple sticks such as blood samples for Labs. If you cant get it get out the room!!

  • Fwestivus
    5 years ago

    Ouch! That bad lumbar puncture sounds a bit like mine, but for the opposite reason – I was lucky enough to have a training Doc do her first one on me… A good 45 mins of jabbing around in my back before they found the right spot.

    Still, it was educational insofar as where various nerves go – a mill or two left or right and the referred pain changes pretty dramatically.

    It’s definitely frustrating at times trying to get treated for invisible problems…

  • Donna
    5 years ago

    I have suffered from migraines since I was a child. When I had my baby, they gave me an epidural and the doctor warned the nurses not to sit me up for at least 24 hours. One of the nurses was not paying attention and sat me straight up in bed. It felt like my head had been blown off with a shotgun! The nurse was fired and my migraines have been a lot more intense ever since and that was in 1978.

  • tonyawhitaker
    5 years ago

    I suffered a spinal headache after receiving an epidural for a cone biopsy of the cervix. The treatment I received was a caffeine IV. It was awesome. My headache went away within an hour. It wasn’t until after the spinal headache that I started having migraines. Has anyone else had this happen ? Are there any doctors that read this that might have heard of this ?

  • Fwestivus
    5 years ago

    I had a lumbar puncture a little while ago (as one of the many fun investigations to try to sort out my chronic migraine) and ended up with a low pressure headache, which seems to be the same as an epidural headache, though far more common, as with a lumbar puncture, you are deliberately CSF out, rather than accidentally leaking a little.

    I can’t say that I could confuse a migraine and the low pressure headache. Or, if one were to confuse it, I’d wonder what sort of migraines you were getting! I had problems with it for about a month or so – it was very painful (almost impossible, in fact) to stand up straight, but not even a touch on migraines or how utterly debilitating they are.

    Sadly, here in the UK, the blood patch treatment is either not available at all or only available in certain areas (depending on which doctor you speak to). So you might end up lumbered with your low pressure headache for a goodly while!

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