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What Causes Persistent Headache After Standing For Long Time?
Question: I had a blood patch over a week ago for a LP that was one week prior. If I'm on my feet for longer than 2hrs I get a huge headache. I can not think and confusion sets in very strongly when this happens. What can I do if a blood patch doesn't work. I also have a hard time urinating. My feet tingle and back still hurts. But what is the next step if a blood patch doesn't work?
My LP opening pressure was 15cm and closing pressure was 9cm.
My LP opening pressure was 15cm and closing pressure was 9cm.
Brief Answer:
Another patch
Detailed Answer:
I read your question carefully and I am sorry you the persisting headache. It is unfortunate as in most cases the headache subsides after a few days and it is rare that the blood patch doesn't work.
Most common next step if a blood patch doesn't work is to have another blood patch. It works works in most patients (success rate is 72-90% for first blood patch and goes up to 96% for the second).
Another possibility if that doesn't work is epidural fibrin glue, a sort of mixture of different plasma proteins which form a highly tensile gel which seals the leak.
If such measures do not work at times (very very rarely needed) surgery is the last resort, hope you will not need that.
I remain at your disposal for other questions.
Another patch
Detailed Answer:
I read your question carefully and I am sorry you the persisting headache. It is unfortunate as in most cases the headache subsides after a few days and it is rare that the blood patch doesn't work.
Most common next step if a blood patch doesn't work is to have another blood patch. It works works in most patients (success rate is 72-90% for first blood patch and goes up to 96% for the second).
Another possibility if that doesn't work is epidural fibrin glue, a sort of mixture of different plasma proteins which form a highly tensile gel which seals the leak.
If such measures do not work at times (very very rarely needed) surgery is the last resort, hope you will not need that.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Should I skip the second blood patch and go straight to the fibrin glue?
My ENT keeps telling me lay flat and drink plenty of water and caffeine.
If I do nothing how long can this keep going?
My ENT keeps telling me lay flat and drink plenty of water and caffeine.
If I do nothing how long can this keep going?
Brief Answer:
Read below
Detailed Answer:
Hello again!
There is no certain way to know how long it can go unfortunately, you are already outside the normal duration, as I said normally symptoms subside inside a few days. The fact headache is persisting indicates there is a persisting leak and as long as it is still leaking there will be headache due to low intracranial pressure. That is the aim of the patch to help seal this leak which is not sealing by itself. Drinking plenty of water and caffeine is fine and may help a little with the symptoms (but only a little) but do not do much about the leak itself.
I would suggest a second blood patch first. As I said results are generally good with a high success rate. Furthermore it is not said that you will be offered fibrin glue option at the facility you are followed, it is not available in every center.
I hope you’ll feel better soon.
Read below
Detailed Answer:
Hello again!
There is no certain way to know how long it can go unfortunately, you are already outside the normal duration, as I said normally symptoms subside inside a few days. The fact headache is persisting indicates there is a persisting leak and as long as it is still leaking there will be headache due to low intracranial pressure. That is the aim of the patch to help seal this leak which is not sealing by itself. Drinking plenty of water and caffeine is fine and may help a little with the symptoms (but only a little) but do not do much about the leak itself.
I would suggest a second blood patch first. As I said results are generally good with a high success rate. Furthermore it is not said that you will be offered fibrin glue option at the facility you are followed, it is not available in every center.
I hope you’ll feel better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I thank you very much. I notice if I take the smallest amount of this diuretic it wipes my out and brings on massive migraine and confusion.
If I have a second blood patch in 9 days is there a higher risk of damaging the disk and the Nerves in the back. My back is killing me when I stand on my feet.
This is what my ENT said that ordered the LP. And I've never had a problem like this before.
"It will go away eventually with or without another blood patch. It's all a matter of how bad it is. Stay off of the Diamox, continue to drink lots of water & caffeine and avoid any straining. Let's see how the next day or so goes. If it continues to get better, I would recommend no blood patch."
Is this true of false. I think he is BS'n me.
I thank you so much for your help. I've been to the ER 3 times now. The ENT that ordered the LP he does skull based surgery. But I do not think he is telling me the truth. A week after the LP He said lay flat. I had been laying flat for 3 days by this time. Be when I would get up the massive headaches would come on. So I went to have a blood patch. But I still have the problems it just takes a couple hours before it starts back up again. The only chance I have to get this fixed is to go to an out of town ER and hope they can fix me. This is my last week I can take from work. My choices are Vanderbilt in XXXXXXX TN or Emory in XXXXXXX Also Saint XXXXXXX in XXXXXXX Which one should I go visit?
I'll take any advice I can get. You have very good advice so I will go where you think.
If I have a second blood patch in 9 days is there a higher risk of damaging the disk and the Nerves in the back. My back is killing me when I stand on my feet.
This is what my ENT said that ordered the LP. And I've never had a problem like this before.
"It will go away eventually with or without another blood patch. It's all a matter of how bad it is. Stay off of the Diamox, continue to drink lots of water & caffeine and avoid any straining. Let's see how the next day or so goes. If it continues to get better, I would recommend no blood patch."
Is this true of false. I think he is BS'n me.
I thank you so much for your help. I've been to the ER 3 times now. The ENT that ordered the LP he does skull based surgery. But I do not think he is telling me the truth. A week after the LP He said lay flat. I had been laying flat for 3 days by this time. Be when I would get up the massive headaches would come on. So I went to have a blood patch. But I still have the problems it just takes a couple hours before it starts back up again. The only chance I have to get this fixed is to go to an out of town ER and hope they can fix me. This is my last week I can take from work. My choices are Vanderbilt in XXXXXXX TN or Emory in XXXXXXX Also Saint XXXXXXX in XXXXXXX Which one should I go visit?
I'll take any advice I can get. You have very good advice so I will go where you think.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the feedback. Sorry for answering a little late but your question had arrived during the night here in Europe and was a very busy day at the hospital.
In principle the ENT hasn't said anything wrong by advising to lie down and wait. When you get up gravity pulls fluid downwards and pressure in the brain is lowered even more hence the headache. Diuretics lower the pressure even more (esp. Diamox as it in addition inhibits cerebrospinal fluid production), so no wonder they make you worse. Lying down can help alleviate the symptoms while with time the tear closes and the leaked fluid is substituted. It is what is generally advised and in most patients works. I as he still hope it works, in some people wounds need more to heal than in others, but after so many days that hope goes diminishing.
Trouble is that yours is being one of those rare cases where that doesn't work and the leakage continues. The blood patch usually helps with that, unfortunately one has still not been enough in your case.
If you can do the second one right now...it certainly represents no risk to the disc, if performed correctly nerve roots should be fine as well. However the local tissue should be inspected by the performing physician for trauma or infections given the repeated punctures and the pain you describe. In that case may be decided to wait some more.
Also if symptoms persist even after, then a spinal MRI should be scheduled to visualize the leak.
As to where you could go, being from Europe I do not have personal experiences with US hospitals. Judging from how they are nationally ranked in the US I would advise Vanderbilt or Emory (rated more or less the same, Emory has a slight edge in Neurology) while Saint XXXXXXX would came third.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Thank you for the feedback. Sorry for answering a little late but your question had arrived during the night here in Europe and was a very busy day at the hospital.
In principle the ENT hasn't said anything wrong by advising to lie down and wait. When you get up gravity pulls fluid downwards and pressure in the brain is lowered even more hence the headache. Diuretics lower the pressure even more (esp. Diamox as it in addition inhibits cerebrospinal fluid production), so no wonder they make you worse. Lying down can help alleviate the symptoms while with time the tear closes and the leaked fluid is substituted. It is what is generally advised and in most patients works. I as he still hope it works, in some people wounds need more to heal than in others, but after so many days that hope goes diminishing.
Trouble is that yours is being one of those rare cases where that doesn't work and the leakage continues. The blood patch usually helps with that, unfortunately one has still not been enough in your case.
If you can do the second one right now...it certainly represents no risk to the disc, if performed correctly nerve roots should be fine as well. However the local tissue should be inspected by the performing physician for trauma or infections given the repeated punctures and the pain you describe. In that case may be decided to wait some more.
Also if symptoms persist even after, then a spinal MRI should be scheduled to visualize the leak.
As to where you could go, being from Europe I do not have personal experiences with US hospitals. Judging from how they are nationally ranked in the US I would advise Vanderbilt or Emory (rated more or less the same, Emory has a slight edge in Neurology) while Saint XXXXXXX would came third.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much,
Yes my back hurts and got warm on it's own lastnight. I used an ice pack to try and help. I defiantly don't want to hurt my nerves anymore but I've got to do something or I'm going to lose my job. I've been off work for 9 days now. I did try a very small amount of Diamox yesturday and it put in a huge state of confusion. It was just a small crum worth.
(I wanted to ask you I did have a beer the same on the same day as the LP. I was in some pain. I had a beer and a shot of whiskey the second day. Can this cause the hole not to seek up as well)?
Or prolong the problem. After the Blood patch that I think the local ER did not do correctly I have not had any achohol. Just a very small amount of Diamox. But I know not to take that now at all.
The other Hospital is UAB in XXXXXXX AL. That was an option too.
The other other Hos
I had two bags of fluids in the ER as well in the last week. Looks like that didn't help.
Yes my back hurts and got warm on it's own lastnight. I used an ice pack to try and help. I defiantly don't want to hurt my nerves anymore but I've got to do something or I'm going to lose my job. I've been off work for 9 days now. I did try a very small amount of Diamox yesturday and it put in a huge state of confusion. It was just a small crum worth.
(I wanted to ask you I did have a beer the same on the same day as the LP. I was in some pain. I had a beer and a shot of whiskey the second day. Can this cause the hole not to seek up as well)?
Or prolong the problem. After the Blood patch that I think the local ER did not do correctly I have not had any achohol. Just a very small amount of Diamox. But I know not to take that now at all.
The other Hospital is UAB in XXXXXXX AL. That was an option too.
The other other Hos
I had two bags of fluids in the ER as well in the last week. Looks like that didn't help.
Brief Answer:
Read below.
Detailed Answer:
I wouldn’t worry or have any regrets about the alcohol consumption, it is not the cause. The Diamox ….well you know about that now, it is used for quite the contrary of what you have, to lower CSF pressure. Fluids are important to keep well hydrated and not have a low blood pressure, but beyond a certain threshold there is not much they can do, if you were already hydrated having iv fluids won’t add much benefit.
If you feel it is swollen and warm to the touch it definitely needs a look to check for the possibility of a local infection of the soft tissue (no panic shouldn’t affect the nerves). As for the issue of the work, I am sorry but it is not something which can be sped up in another way. The concern for another puncture is as much valid for fibrin glue as it is for blood patch, any of the options involve either a puncture or surgery (which will need MRI and planning beforehand).
As for University of Alabama hospital, while it is a fine one and the best in Alabama it doesn’t offer on paper anything extra to Vanderbilt or Emory which are ranked slightly above (though more or less at the same level).
Read below.
Detailed Answer:
I wouldn’t worry or have any regrets about the alcohol consumption, it is not the cause. The Diamox ….well you know about that now, it is used for quite the contrary of what you have, to lower CSF pressure. Fluids are important to keep well hydrated and not have a low blood pressure, but beyond a certain threshold there is not much they can do, if you were already hydrated having iv fluids won’t add much benefit.
If you feel it is swollen and warm to the touch it definitely needs a look to check for the possibility of a local infection of the soft tissue (no panic shouldn’t affect the nerves). As for the issue of the work, I am sorry but it is not something which can be sped up in another way. The concern for another puncture is as much valid for fibrin glue as it is for blood patch, any of the options involve either a puncture or surgery (which will need MRI and planning beforehand).
As for University of Alabama hospital, while it is a fine one and the best in Alabama it doesn’t offer on paper anything extra to Vanderbilt or Emory which are ranked slightly above (though more or less at the same level).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank very very much,
It is swollen at the buttom on my and fills softer than normal. I did notice that yesturday. Still fills abnormally sift going up the spin as well. I thought it was from laying down so much.but that explains the tingling and the worm filling in my back.
Should I still push forward with another blood patch.
It is swollen at the buttom on my and fills softer than normal. I did notice that yesturday. Still fills abnormally sift going up the spin as well. I thought it was from laying down so much.but that explains the tingling and the worm filling in my back.
Should I still push forward with another blood patch.
Brief Answer:
Read below.
Detailed Answer:
I am afraid you first phrase is not complete, one or two words are missing, says simply "swollen at the buttom on my and" it is unclear at the bottom of what and on what. Anyway some soreness is acceptable as long as it's improving, the concern is of some local infection at the puncture site which should be suspected if pain is increasing, there is local temperature and/or fever.
Given that it has been 9 days already since the blood patch and you state no improvement at all I believe you should push for another, of course the performing physician will check the area beforehand, should leave it to him. You mention only ER, but since it is an epidural injection (shouldn't puncture the dura - tougher technically than a spinal one) it would be preferable if it was an anesthesiologist if possible.
Read below.
Detailed Answer:
I am afraid you first phrase is not complete, one or two words are missing, says simply "swollen at the buttom on my and" it is unclear at the bottom of what and on what. Anyway some soreness is acceptable as long as it's improving, the concern is of some local infection at the puncture site which should be suspected if pain is increasing, there is local temperature and/or fever.
Given that it has been 9 days already since the blood patch and you state no improvement at all I believe you should push for another, of course the performing physician will check the area beforehand, should leave it to him. You mention only ER, but since it is an epidural injection (shouldn't puncture the dura - tougher technically than a spinal one) it would be preferable if it was an anesthesiologist if possible.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question,
Can I die from a CSF leak?
Can I die from a CSF leak?
Brief Answer:
No
Detailed Answer:
No, that is not the concern, a small leak from a puncture needle won't lead to anything of the kind.
I know the headache is intense, it causes disability and it is really unfortunate you are not recovering not as easily as most people, but you have no reason to fear for your life, rest assured about that.
No
Detailed Answer:
No, that is not the concern, a small leak from a puncture needle won't lead to anything of the kind.
I know the headache is intense, it causes disability and it is really unfortunate you are not recovering not as easily as most people, but you have no reason to fear for your life, rest assured about that.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Bless you,
Even taken the Diamox with low CSF. Can that cause Brain damage?
Even taken the Diamox with low CSF. Can that cause Brain damage?
Brief Answer:
No.
Detailed Answer:
No, not caused brain damage, simply exacerbated the symptoms.
There is no brain damage for your type of intracranial hypotension, only in some cases when it has gone unrecognized and untreated for years it may gradually influence higher mental functions, but that is clearly not your case.
Hopefully you will be back to your old self in a matter of days or weeks at most.
No.
Detailed Answer:
No, not caused brain damage, simply exacerbated the symptoms.
There is no brain damage for your type of intracranial hypotension, only in some cases when it has gone unrecognized and untreated for years it may gradually influence higher mental functions, but that is clearly not your case.
Hopefully you will be back to your old self in a matter of days or weeks at most.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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