Spinal Headache Prevention Information Home Page
(Post Dural Puncture Headache Prevention Information)
Page updated September 9, 2009.
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Have you been or will you be a spinal anesthesia or lumbar puncture (spinal tap) patient?
Are you an anesthesia practitioner or neurologist?
If you answered yes to either of the above, you need to read this article!
Spinal Headache is totally preventable.
I am a retired anesthesiology assistant professor. I taught anesthesiology, specifically spinal anesthesiology, for nearly 20 years. By using the specific technique described below, ALL 4400+ of my patients and my students' patients have TOTALLY avoided the excruciating pain of spinal headache, a far-too-frequently-occurring side-effect of spinal anesthesia and lumbar puncture (spinal tap).
I have spent the last twenty years attempting to spread the word on this technique, which has worked flawlessly in avoiding headache in even the most headache-prone cases: obstetrical cases. Most recently, my article article below was published by the Regional Anesthesia Journal in 1995. Finally, the Internet provides the opportunity to reach the general public.
Sadly for spinal anesthesia and neurology patients, the medical community has largely ignored these discoveries. I believe that one reason is that my technique uses a very inexpensively manufactured non-patented needle (about $0.50 cents each). By contrast, the most popular anesthesia needles today use PATENTED designs which are hard to manufacture, and consequently command prices of $25.00 and up. Clearly, if my technique were widely adopted, the needle manufacturers would lose tens or hundred of millions of dollars in profits. Need I say more? (Also, the availability of low-cost headache-free spinal anesthesia would be significant in developing countries.)
I have seen patients (not mine, of course) suffering from spinal headache after surgery or spinal tap. Their pain is excruciating. Even the strongest pain killers like morphine cannot alleviate their pain. Of course, I feel that it is far better to avoid the physiological mechanism which CAUSES the spinal headache in the first place.
The physical phenomenon which causes spinal headache is very simple: In an spinal tap or spinal anesthesia, when the needle pierces the inner tube ("dura") in the spine which contains the spinal cord itself, the spinal fluid in which the spinal cord is bathed can leak out (sort of like a leak in a garden hose). However, unlike a garden hose, there is not an infinite supply of spinal fluid, so the pressure of the fluid inside the dura drops as the fluid leaks out. The next part is key: There is a membrane at the base of the skull which separates the spinal fluid from the fluid in which the brain floats. Normally, the fluid pressures are balanced, and there is no problem. But, if spinal fluid leaks out through a needle hole, the pressures become imbalanced, and the cushioning effect of the fluid disappears and tension is applied directly to these nerves. The degree of pressure imbalance determines the degree of the headache. This part of the understanding of spinal headache is widely understood and undisputed.
Now the interesting part:
Previous "conventional wisdom" in preventing or alleviating spinal headache has generally gone along three lines: (1) Use a smaller or higher-tech needle, make a smaller hole, and less fluid will leak out, so headache will be milder or less prevalent. (2) Hydrate the patient (pump fluids into him) after surgery to help spinal fluid production and thereby re-balance the fluid pressure, relieving headache sooner. (3) Use a "blood patch" to plug the needle hole. None of these techniques has been effective in eliminating spinal headache. The rate of headache has decreased, but NOT to zero!
Most anesthesiologists will tell you that the "likelihood" of spinal headache is low - maybe a few percentage points. (Obstetrical cases can have a 20 to 30% likelihood). The "few percentage points" may be of comfort the to patient before anesthesia, but is no comfort afterwards if he or she is one of the hundreds of thousands who have fallen into that "few percent". (Even more frustrating to me when I hear from patients who have written or e-mailed to me AFTER getting the headache - one headache-debilitated patient's suffering lasting over 2 months!)
My technique (unconventional wisdom) is very simple: Make a self-sealing hole! No fluid leak! No headache!
This concept is very simply summarized for the layman by the following illustration. There are the two primary reasons that physicians puncture a patient's dura: 1) In spinal anesthesia, the anesthetic drug must be delivered into the subarachnoid space. 2) In a diagnostic spinal tap, it is the fluid of the subarachnoid space which the physician is attempting to sample. In addition, dura puncture can also occur if the physician is attempting to do epidural anesthesia, but accidentally over-penetrates.
The headache-causing activity in all of these is the subsequent leakage of fluid from the subarachnoid space into the epidural space. In the body, the dura is a tube much like a garden hose, with high pressure liquid inside that is trying to "get out". Note that the subarachnoid space fluid is normally under considerably higher pressure than the epidural space. To prevent headache, you want to eliminate fluid flow out of the subarachnoid space (out of the dura) into the epidural space (closer to the patient's skin).
If a beveled needle makes a perpendicular puncture, as in (A), then a "saloon door"-like opening is created, which can open in either direction and allow spinal fluid to flow out of the dura (hence the spinal headache).
A puncture at an angle with the bevel cutting the dura outward, as in (B), creates a flap which will also allow spinal fluid to flow out of the dura (hence the spinal headache).
A puncture at an angle with the bevel cutting the dura inward, as in (C), creates a flap which will close behind the needle as it is withdrawn by the physician. The hole is self-sealing. Spinal fluid leakage is minimized, and headache is prevented!
Please read the article by following the link below. It was published in the Regional Anesthesia journal in 1995. Please give a copy of it to your anesthesiologist. Ask him what technique he will use, and what the likelihood of spinal headache is. Finally, if you get a spinal headache (you'll know - there's no mistaking it), be angry - because it probably could have been avoided!
If you found this page because you believe you have a spinal headache (or have other questions), please check out the "Frequently Asked Questions" section.
To see a few samples of how people are sufferring - needlessly - and some other e-mail, please click here. This is WHY I have this web site! Read the e-mails, and you too will understand the human stakes involved!
To read the full article, with all illustrations, please click here. Please note that the detailed graphics take a few minutes to download.
This page is JUST STARTING CONSTRUCTION... please be patient...Encouragement in the form of e-mail or regular mail would be much appreciated!
E-mail comments to Dr_Bela_Hatfalvi@PREVENT-PDPH.ORG
With great sadness, the webmaster must report that Dr. Bela Hatfalvi died in 2008. He was 95 years old. This web page is being maintained both as memorial to him and his work and so that more patients can benefit from his discoveries. The above email address is monitored by the webmaster, but no medical advice can be given. Please refer to the Frequently Asked Questions link above.
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.
Bela I. Hatfalvi, M.D.
Assistant Professor of Anesthesiology (Retired)
Retired from: Department of Anesthesiology, Barnes Hospital at Washington University, One Barnes Hospital Plaza, St. Louis, MO 63110
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