The Blood Patch: Info You Can Use

| April 20, 2013 | 9 Comments

So you are getting a blood patch for a spinal headache.  What is a blood patch?

This is a procedure performed by anesthesiologists to help relieve a spinal headache, or a “post-dural puncture headache”. The spinal headache is classically described as postural in nature.  When the patient assumes a sitting or standing position, the headache is present or gets worse.  When they are laying down, the headache goes away or is significantly improved.

There are several theories as to why a spinal headache occurs, but it usually is seen after a lumbar puncture or spinal anesthesia.  It can occur after an epidural placement as well.

The thought is that the hole made in the dura to inject spinal medicine or remove spinal fluid for testing, can continue to leak spinal fluid.  This is then thought to cause the brain to “sag” when a patient sits or stands up.  And this phenomenon can translate in a robust headache.

Another thought is that when a patient assumes a vertical position, there is more pressure in the spinal space, more spinal fluid leaks out, and the vessels in the brain increase in size to compensate.

Regardless of the mechanism of a post-dural puncture headache, if your doctor believes you have a spinal headache, a blood patch may help.

During a blood patch, a small volume of blood drawn from an iv is injected into the epidural space to “patch” the hole in the dura.  I will not attempt to quote statistics, but a blood patch usually helps right away.

This is if the headache is truly a post dural puncture headache.  If the blood patch doesn’t work, it may mean that the headache is from a multitude of other potential causes.

I don’t mention this to downplay the significant discomfort caused by a spinal headache, but rather to alert you that there may be other causes.  And the post dural puncture headache may be hurting you on top of another type of headache as well.

The process for placing a blood patch is similar to that for the placement of a labor epidural.  The added step is that blood is drawn from your iv to be placed into the epidural space.  When the blood is used as the patch, it often will cover the dural hole until it can close on its own.  And hopefully by the time your body absorbs the blood clot that was used as the patch, the hole in the dura will be closed up.

If you have had a post dural puncture headache, or a blood patch, let us know what your experience meant to you.  The hope is that we can learn from you and others can hear what worked for them.

Thanks for stopping by anesthesiamyths.com.  Please feel free to leave a comment below, contact us, or visit the forum.

Stay healthy!

Tags: , ,

Category: Anesthesia Topics, Obstetric Anesthesia, Regional Anesthesia

Comments (9)

Trackback URL | Comments RSS Feed

  1. jennmeadows says:

    My husband had an epidural for a bulging disk on Monday 2/11. Shortly after his severe headache, neck pain and left shoulder pain started. We were not informed of any possible complications. On Tuesday 2/12 I googled his symptoms and came up with dural puncture so we immediately went to local ER. They performed a blood patch. Gave him Reglan, Lortab 5 and Naproxen to take home. The pain lessened and we returned home. The whole time he stayed in the bed and drank lots of caffeine. The pain increased and on Thursday we returned to the ER. They stated another blood patch could not be performed so they gave him Morphine and Phenegran injections and we went home again. The pain continued and was worse upon sitting and standing since it began. Continued with take home meds and even tried Excedrin Migraine and Goodys powders. Also sporadically taking muscle relaxers. Pain continued through weekend and on Monday 2/18 had an appt with family doctor. He stated pain should be better so direct admit to another hospital. Once admitted they did ct scan that showed no issues. Gave dalaudid, robaxin and lortab in between with no relief. Worse pain than at home. On tuesday 2/19 the did an mri with no issues. Another blood patch was done today. Pain still severe after patch. Hurts to eat sandwich. Not sure why no relief. Please help with answers.

    • Dr Dave says:

      Jennifer,

      I am sorry to hear about the problems your husband is having after his epidural. And I’m sorry to hear about the “informed consent” issues.

      Let me start off by saying I can’t give you any specific medical advice regarding your husband. But I can try to provide you with some more general medical information so that you can better understand the situation.

      Post dural puncture headaches, although rare, can occur following epidural placement. These headaches are typically postural in nature: they get worse on sitting-up/standing and get better when lying flat.

      Something like 90% of spinal headaches improve following a blood patch. That number jumps to about 95% after a second blood patch.

      And these headaches typically improve on their own, even without a blood patch, within about two weeks.

      If two blood patches have not been successful, it may mean that the headache has a different cause. The CT scan and MRI are sometimes helpful in figuring that out.

      Have his physicians mentioned anything about meningitis? If they were concerned about this, they may decide to do a lumbar puncture. This is a procedure where they take and examine some of the cerebrospinal fluid for signs of infection.

      I am assuming there isn’t a previous history of neurologic disease that could explain some of what’s going on.

      I am also assuming an epidural steroid injection was performed to help with the pain from the bulging disc.

      I’m not sure if you are aware that there was an outbreak of fungal meningitis last fall in patients that had epidural steroid injections. You can read more about it on the CDC’s website here:
      http://www.cdc.gov/hai/outbreaks/patients/faq-meningitis-outbreak-patients.html#steroidinjection

      I don’t want to scare you and I am not suggesting that this is what is going on with your husband. It’s impossible for me to know that over the internet.

      But it sounds like you are looking for more information, and that’s what I’ve tried to provide.

      I hope this information is helpful to you. Your husband is in my thoughts and prayers. Please update us on his condition.

      Dr. Dave

  2. I got a spinal headache after 2 out of 3 c-sections. The pain! Wow! I was wearing sunglasses in the hospital room and all lights had to be off and shades drawn, everyone and everything seemed so loud, my head hurt so bad. The sound of my babies crying was enough to bring me to tears too. The second spinal headache was a little different than the first so I didn’t know what was going on until it got very painful and included all of the symptoms (it started with a slight headache which I attributed to surgery and ringing in my ears vs. light sensitivity and instant, major headache of my first one).

    I requested a blood patch both times and while the anesthesiologists weren’t thrilled about doing them, they went ahead and preformed the procedure. I laid down for 25 minutes and the headache vanished! It was like heaven opened up! I was able to bond with my babies better and enjoy lights and sounds again. I had some pain in my thighs after my second blood patch, which stayed for a couple months and was kind of weird feeling; but it was soooo worth it!

    I always wondered if I got the spinal headache because they had a hard time placing the needle before those 2 c-sections. They had to try quite a few times. The only c/s I didn’t get one was when the anesthesiologist got the placement perfectly after 2 tries.

    I always tell my friends if they feel like they are getting one, ask immediately for the blood patch!

    • David Draghinas says:

      Thank you for sharing your experiences. I’m sorry to hear that you’ve had difficult spinals, spinal headaches, and blood patches. Yes, difficulty placing spinals with multiple attempts does increase the chances of getting a spinal headache afterwards.

      And if someone does indeed have a spinal headache, a blood patch is extremely effective in improving the symptoms of the spinal headache.

      Thanks again for your detailed comment.

      Dr. Dave

  3. Irma Hernandez says:

    I have had four epidurals and one blood patch. My headache start during my delivery about 30 mins after the epidural. I gave birth on 3/4 and get the blood patch until Friday 3/7, my headache was so bad I could hardly walk without feeling that my head was going to fall because it felt so heavy, the light and sound bother me. The only thing that made me feel better was laying down complete flat and placing the pillow and covers on my face. The doctor had me drinking caffeine pills coke , Mountain Dew, and tea but that didn’t really help just gave lots of gas which is a little uncomfortable especially after giving birth. So on Friday I finally got the blood patch which I most say took away my headache immediately during the procedure but it was one of the worst pains I have ever felt You feel the blood entering you body the pain goes down your leg and down to your knee. But I guess that the pain was only for no more than 5 mins and the headache was gone however I most say that you do stay with bCk pain or discomfort. Today is Sunday 3/9 and I have feeling back pain and tenderness on my lower back hopefully all of this goes away soon.
    But ladies the blood patch is pain is better than a epidural headache any day!!!! I hope this helps I just want to share what I’m feeling not make it seem as if it were painless

  4. Bobbie Flener says:

    I has an LP done on 8/8/2014 and today is 8/12-2014 and I’m on my way to have a blood patch done. My question is.., is it gonna hurt just as bad as the LP

    • David Draghinas says:

      Bobbie,

      My hope is that you will have a better experience this time.

      LPs are often performed by physicians other than anesthesiologists. And a different type of needle is typically used for LPs as well.

      Epidural blood patches are performed by anesthesiologists, with a different kind if needle.

      You should see immediate improvements to your spinal head ache with the blood patch.

      Please let us know how it went.

      Dr Dave

  5. Michelle says:

    My son had an LP on 8/14 and still has a headache today. He plays college football. Do you recommend the blood patch? Is it safe? Are there major risks?

    Thanks, Michelle

    • David Draghinas says:

      Hi Michelle,

      An epidural blood patch is the best and fastest-working treatment for a spinal headache. It tends to work almost instantaneously in a vast majority of patients.

      After evaluating your son, if the anesthesiologists believes he has a spinal headache, he/she will offer an epidural blood patch. It has the side effect and risk profile of epidurals. Risks are pretty small for healthy people.

      The difference with a blood patch is that about 20 ml of the patient’s own blood will be sterilely placed in the epidural space.

      As parents, we are always concerned about our children’s health (regardless of their age). In medicine, we always have to consider risks, benefits, and alternatives. If he is still experiencing these headaches, it is worth being evaluated and considering a blood patch.

      Please let us know of any updates. He’s in my thoughts and prayers.

      Dr. Dave

Leave a Reply