What Is An Epidural Blood Patch?
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A spinal headache develops in 10-40% of individuals who receive lumbar punctures to treat certain medical conditions. A patch can effectively seal the leak at the site or relieve low pressure states in the head. Spinal headaches may also be referred to as chronic post dural puncture headaches, which refers to the cause of pain.
How Does A Patch Work?This procedure was used for the first time in 1960. The epidural space is a sac that encases the spinal cord. This site contains cerebrospinal fluid. This fluid circulates from the spine to the brain. If a lumbar puncture causes it to leak, pressure in the brain begins to decrease. This patch restores the optimal pressure in the brain by sealing the leak.
Conditions Related To An Epidural Blood PatchWhen headaches become chronic, people usually seek medical advice. Persistent headaches may develop due to a number of conditions. Clinicians generally try to determine their primary cause with imaging tests and different clinical assessments. If a person has a history of spinal injection procedures, it could indicate that a lumbar puncture is leading to spinal headaches. You may have undergone a spinal injection for any of the following reasons:
- Pain management (e.g., epidural injection)
- An epidural to assist with labor
- Spinal anesthesia for surgery
- A myelogram (contrast dye administered to the spinal cord during imaging screening)
If an individual is suffering from persistent headaches and has undergone one or more spinal injections in the past, their cerebrospinal fluid may be leaking. This can be responsible for their pain. A 10% loss of cerebrospinal fluid is enough to cause a spinal headache.
The International Headache Society defines a post-dural puncture headache as a headache that:
- Presents approximately five days after a spinal injection
- Intensifies while sitting in an upright position for about ten minutes
- Has additional symptoms of vomiting, neck stiffness, nausea, and hearing issues
Further, individuals who lay down for 30 minutes usually report experiencing relief after a spinal headache.
Patients most at risk for these headaches include:
- Women who were given an epidural to assist with their labor
- Individuals whose ages range from 31 to 50
- Those who received epidural injections when large bore needles were used, up to 16-86% of individual patients
How Is An Epidural Blood Patch Performed?Before the procedure begins, your doctor will draw 15 to 20 milliliters of blood. Next, you’ll receive an injection that contains an anesthetic to numb the targeted region. Your doctor will inject your withdrawn blood into the site where the leak originated. This injected blood gradually begins to clot. It will form a seal over the leak.
The patch procedure usually takes 30 minutes. Most people experience relief almost immediately after the epidural blood patch treatment.
The procedure can be repeated if pain relief is not experienced the first time. However, it only needs to be repeated in about 5% of all cases.
Does It Work?A recently-published study showed that blood patches can help. They can lead to a significant decrease in the duration and intensity of headaches. Results indicate that this treatment approach is a viable option for people who experience post-dural puncture headaches.
Research has also repeatedly indicated that an epidural blood patch is a standard form of treatment for spinal headaches that develop due to lumbar injections that cause unexpected puncture wounds. However, current studies have also assessed the ability of patches to effectively treat headaches for patients who:
- Received an implantation with an intrathecal pain pump
- Underwent spinal fusions
According to clinical reports, this typically results in positive outcomes for patients who suffer from headaches after undergoing both of the aforementioned treatment methods.
In addition, one particular case study showed that patches can be used to effectively treat a patient who had lumbar puncture-induced vertigo. The patient did not report experiencing any headaches although their vertigo was significant. However, the dizzy spells as well as all the symptoms related to the vertigo, immediately disappeared after the procedure.
What Are the Side Effects of a Blood Patch?This treatment method is minimally invasive, but it is associated with certain complications. Some side effects may include:
- Nerve damage
- An infection at the injection side
- Abdominal cramping
The occurrence of these side effects is rare. Some patients have also reported feeling discomfort and mild pain for several days after undergoing this procedure.
ConclusionAn epidural blood patch is a treatment method where a blood sample is taken from a patient and then injected into the epidural space shortly thereafter. This method is commonly used to treat patients with spinal headaches. These headaches occur from a lumbar puncture that subsequently led to a cerebrospinal fluid leak. These patches seal the site of the leak and restore the optimal pressure in the brain. In doing so, they effectively treat lumbar puncture-related conditions.
This treatment method is minimally invasive. It usually takes 30 minutes to complete. Further, it has consistently demonstrated the ability to provide patients with significant relief.
For more information about this pain-relieving procedure, click the button below to find a pain specialist in your area. They’ll be able to discuss whether or not this treatment is a good option for you.
References and Further Reading
- Ahmed G, Arjang K, Mangar D. Post-dural puncture headache. Int J Gen Med. 2012;5:45-51.
- Burnett C, White A, Vulcan M. Epidural Blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Op J Anesth. 2013;3:168-169.
- Kokki M, Sjovall S, Keinanen M, Kokki H. The influence of timing on the effectiveness of epidural blood patches in parturients. Int J Ob Anesth. 2013;22:303-309.
- Madsen S, Fomsgaard J, Jensen R. Epidural blood patch refractory low CSF pressure headache: a pilot study. J Headache Pain. 2011;12:453-457.
- Oedit R, Van Kooten F, Bakker SLM, Dippel DWJ. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomized, observer-blind, controlled clinical trial. BMC Neurol. 2005;5:12.
- Vazquez R, Johnson D, Ahmed S. Case Report – Epidural blood patch for postdural puncture position vertigo. Pain Medicine. 2011;12:148-151.