Generally speaking, once a dura puncture has been done, if a headache ensues, the primary options are to wait it out (with or without analgesics) or to perform a blood patch. Bear in mind that a blood patch is not always successful (sometimes unsuccessful twice and three times) and has its own possible serious side effects, such as hematoma or infection among others. Any invasive procedure has possible side effects which must be considered against the benefit of the contemplated procedure.
While the safety of any procedure, including blood patch, is relative, blood patch is widely performed in the United States to alleviate severe spinal headache. Spinal headaches generally last 3 to 7 days. (Usually, by this point the patient's headache has subsided or the excruciating pain has driven the patient to beg for a blood patch.)
In rare cases, spinal headache can last for months. Unfortunately, prediction of the length of headache is a guessing game.
As with any medical complication, consultation with a trusted physician is the prudent course of action. It is critical to note that headaches and pain may be caused by conditions other than spinal fluid leakage following spinal tap or spinal anesthesia. It may be useful to consider referrals to teaching hospitals (hospitals associated with medical schools) if you are not satisfied with the performance of your personal physician.
Without sounding flip, I am really not the person to ask about getting rid of spinal headache. Not a single one of the 4400+ patients under my care ever had such a headache. I have never had to deal with "fixing the problem". I can speak with authority, however, on how to PREVENT spinal headache. I am very sorry if you are reading this too late.
This is one very good example of where an ounce of prevention is worth a pound of cure.
There is no list currently maintained of doctors who use this technique. I recommend that prospective patients discuss this technique with their doctor.
If enough doctors are interested in being so listed, I would consider starting such a list.
Spinal headache after a spinal tap or spinal anesthesia (or epidural anesthesia) is relatively uncommon, anywhere from 1% to 30% based on published reports. There has been no reported deaths from spinal headache. The anesthesia and neurology communities are relatively satisfied with the current 1% to 30% headache rate. Quite frankly, many anestheiologists are not interested in "rocking the boat" of their practice. They are accustomed to performing spinal anesthesia and spinal taps a certain way, and that is that. While this may seem abhorrent to the patient, remember that the doctor charges EXTRA for the blood patch to alleviate spinal headache! I think it is shameful that anesthesia practitioners and neurologists cause the spinal headache by virtue of their inferior technique and then have the nerve to charge the patient to alleviate the pain!
Of course, manufacturers of spinal needles are very much against this technique also. The reason is simple: money! My technique uses an inexpensive needle with a very small profit margin and much competition. Why should they promote a technique which will kill their "cash cow"? Today's newest high-tech needles cost $25.00 and up. Today, the vast majority of all spinal taps and spinal anesthesia are done using those expensive needles (Whitaker, Sprotte, etc). My technique uses a $0.50 needle - that's right - 50 cents! Do the math!
I like to compare this situation to that of the discovery of the Helicobacter pylori bacteria, and its now-accepted relevance to peptic ulcer disease. Up until a very few years ago, peptic ulcer disease was usually treated with surgery: cutting out large parts of the patient's stomach. This was medical science! The "standard treatment" was surgery. Nobody argued its wisdom; it was just the accepted standard of practice. Patients with peptic ulcer disease did get one choice in the last few decades: lifetime drug dependency. Several pharmaceutical companies came out with "H-2 Antagonists", with brand names like Tagamet, Zantac, Axid, and Pepcid (now available over-the-counter). These drugs made billions of dollars in profit for those companies. It also kept gastroenterologists busy: the drugs were prescription-only. Then, in 1983, two obscure doctors (Dr. Robin Warren and Dr. Barry Marshall) published a letter in the medical journal Lancet, which suggested that peptic ulcer disease was caused by a bacteria! (Bacterial infections, of course, are treated with antibiotics.) This suggestion was ignored or ridiculed for over a decade. Peptic ulcer disease wasn't a problem for the drug companies - it was their cash cow! They were making billions with the Pepcid-dependent, Axid-dependent, and other drug-dependent patients. Why should they research possible ways to eradicate a bacteria with a few doses of an antibiotic, when they could "treat symptoms" with a lifetime of expensive drugs like Pepcid? How many millions of patients sufferred needlessly because of their greed? It wasn't until 1994 - over a decade later - that the National Institutes of Health convened a panel of doctors to even consider the relevance of Helicobacter pylori to peptic ulcer disease. Today, many doctors are still unaware of the significance of H. pylori and are still treating peptic ulcer disease with "symptom-reducing" drugs, rather than eradicating the disease-causing bacteria. It has been 15 years since the publication of the original article in Lancet. Needless to say, patients are expected to be "patient". How many patients have died in the last decade and a half from stomach cancer caused by H. pylori. It has been shamefully slow progress with H. pylori because of two things: drug company greed and the reluctance of doctors to accept the idea that they were wrong. I see the problem and the resolution of spinal headache as a VERY SIMILAR situation.
You, the reader. If you are an anesthesia practitioner, you will learn. If you are a patient, you will pose lots of questions to your doctor.
The in-vitro experiment with real human dura, as described in this ariticle, is very easy to reproduce - and extremely convincing. Please send your name and address to Dr_Bela_Hatfalvi@go-aps.com, and I will send you everything you need (except for the human dura, food coloring, the manometer, and the syringes). You can try this in less than a half day! Aren't your patients worth that investment? Best of all, I am making this kit and giving it away for free (in single quantities only).
I am an anesthesiologist, not a fortune teller. I do not know if this will be your pot of gold one day.
Standard Disclaimer: This page is not attempting to give medical advice in specific cases, but rather is providing educational information. Please discuss your medical condition with your personal doctor.