How an Epidural is Administered
The anesthesiologist will start the epidural procedure by cleaning off the mother’s back with an antiseptic solution. Then the area of the injection is numbed with several local anesthetics. Once the local anesthesia has taken effect, the anesthesiologist will place the epidural needle in between the spaces in the mother’s vertebrae in the lumbar region. The needle is inserted into an area known as the “epidural space” which is extremely narrow. Just past this space is the membrane which encases the spinal fluid and spinal cord, known as the dura.
Once the needle is in the epidural space, a small catheter is threaded into the needle, through which the medication is administered. The epidural needle is then removed so that all that remains in the mother’s back s the tiny catheter. The medication that is then fed through the catheter usually includes an anesthetic such as bupivocaine as well as a narcotic-analgesic such as fentanyl.
What Causes an Epidural Headache?
An epidural headache is caused when the epidural needle inadvertently goes too deep past the epidural space and punctures the dura. This dural puncture causes a leak of spinal fluid into the epidural space. The leaking of spinal fluid into the epidural space causes a low pressure headache. This type of headache happens about 1-2% of the time when a spinal, epidural or a combined spinal-epidural is administered
Signs of an Epidural/Spinal Headache
One of the tell-tale signs of an epidural headache is that there is more pressure in the front or back of the head and neck when the mother is sitting or standing up. Her head will often feel much better when she is lying down.
Mothers typically report that an epidural headache feels inherently different than other headaches they have had in the past and it is moderate to severe in intensity. The headache can come on as early as one day after birth and as late as one week after the baby arrives.
How are Epidural Headaches Treated?
In most cases, bed rest, drinking plenty of fluids, adding some caffeine to your diet and over the counter pain medications are all that is needed. If the epidural headache persists, a blood patch can be used to alleviate the pain. The anesthesiologist will administer another epidural to the mother and inject a small amount of her own blood to “patch” the leak in the dura. A blood patch relieves the epidural headache in 80% of mothers within a few hours. In the rest, a second blood patch can be done to get rid of the headache.
There is a risk of a headache with either an epidural or spinal. The good news is that there is a variety of effective treatment so there is no need to suffer from the pain of an epidural headache in the early postpartum period.