Headaches affect one in 150 women after they have been given epidurals

May 5, 2018

One in 150 women continue to get headaches after they are given epidural pain relief during childbirth despite medical advances, a meeting of anaesthetists will hear this weekend.
According to Dr Matt Rucklidge, specialist anaesthetist at King Edward Memorial Hospital in Perth, Western Australia’s largest maternity hospital, the proportion of women who experience headaches after an epidural procedure remains largely unchanged over the last decade despite advances in medical technology and procedures.

In Australia, about one in three women are given an epidural for pain relief during childbirth. A local anaesthetic is injected into the space around the spinal nerves in the lower back.

“In about 1 in 150 women, the epidural procedure is complicated by a ‘dural puncture’ in which the epidural needle unintentionally punctures the membrane, the bag of fluid that surrounds the spinal cord. If this happens, most will develop a headache that typically occurs within 48 hours, but can occur later, and may last for several days,” Dr Rucklidge explained.

Over time, the membrane usually repairs itself, but in some cases another epidural procedure is required to help repair it.

“Most ‘post-dural puncture’ headaches settle over time but in some cases the impact can be incapacitating. This can be very difficult if you are a new mother or have other children to look after at home. It can lead to prolonged hospital stays and difficulties caring for the new baby.

“When you are lying flat you don’t have much of a headache but it hits you as soon as you get up. Even though you may not want to get your head off the pillow there’s no evidence that lying in bed makes the headache resolve any quicker.”

Dr Rucklidge is speaking at the “Obstetric anaesthesia….delivering what matters” meeting in Sydney on Sunday May 6.

“The number of women experiencing these headaches really hasn’t changed over the last decade,” he said.
“There has been a large amount of research into how we manage these headaches but very little interest in how to reduce the root cause.

“Even if we could reduce the incidence of these headaches occurring to one in 300 women that would mean a significant number of women who would be spared from having these headaches. But the challenge is ‘how can we do that?’”

Dr Rucklidge said an epidural, while a common procedure practised by most anaesthetists, is “one of the harder skills to acquire”.
 
“Teaching the epidural technique is not straight forward as key steps of the procedure require an appreciation of the ‘feel’ of the tissues as the needle is advanced,” Dr Rucklidge explained.

“If we can provide better and more focused training this may result in fewer headaches for not just our patients but for those learning and teaching this challenging procedure.”

Treatment for epidural headaches includes simple interventions such as staying hydrated by drinking more water and taking pain relieving tablets.  

Women with more severe headaches may be offered an epidural blood patch. This involves an injection of their own blood into the epidural space. The blood clots around the punctured membrane and prevents a further leak of spinal fluid which often cures the headache.
Copyright © Australian and New Zealand College of Anaesthetists.