Lumbar Puncture - Spinal Headache - Epidural Blood Patch
As reported earlier, the Lumbar Puncture went well in that I did not have any vasovagel response and we were able to successfully draw the cerebral spinal fluid (CSF). With the removal of the CSF, a headache usually develops due to lower than normal pressure (or a vasodilation compensatory response). The headache goes away as the CSF replenishes itself naturally.
Except that sometimes it doesn't and you get spinal headaches. Also known as a "headache like no other" - although I would have to imagine that migraines are worse. The usual treatment is bed rest (keeping horizontal keeps the CSF pressure up a little bit), caffeine (it constricts the vessels, increasing pressure) and fluids (again, to increase the pressure) while allowing the hole in the spinal dura time to heal (the hole that was created to remove the CSF).
Except that sometimes, these steps aren't enough. At that point the standard treatment is the Epidural Blood Patch. In this procedure, blood is withdrawn and then injected into the epidural space just outside the dura. The idea is that the blood will form a clot over the hole in the dura and the CSF leak will be repaired. In addition, the injection of fluid will increase the pressure and provide additional relief.
Now as to my case....
Monday - Lumbar Puncture; Monday night headache - but not too bad
Tuesday - Light activities, headache present, but not horrible
Wednesday - Headache bad; Bed rest begun
Thursday - Epidural Blood Patch performed
As I type this I have the sense that it did not work - which happensin about 1/20 cases. The standard approach would be a repeat treatment. If we weren't planning to travel to NYC tomorrow. Time will tell. Watch this space.