What is an Epidural Blood Patch?

Epidural blood patches explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Cerebrospinal FluidThe epidural space is an area within the vertebrae (bones) of the spine, surrounding nerves that extend from the spinal cord (the spinal nerves). A blood patch is the injection of blood into this space. In 1960, it was discovered that this could treat a specific type of headache, called a lumbar or dural puncture headache. Puncture headaches are a common consequence of procedures involving the injection or needle insertion into the spine, occurring in up to 40% of cases.

The epidural space also contains the cerebrospinal fluid (CSF)-filled membrane that surrounds the spinal cord. This fluid is present all along the spine and in the brain. When there are deficits in CSF, which can occur in lumbar puncture procedures, these cause a decrease in the pressure within the brain. An epidural blood patch seals tears in the membrane and restores this pressure to normal.

How is an Epidural Blood Patch Performed?

Epidural Blood PatchIn preparation for this procedure, about 15-20ml of blood will be drawn from the patient. A local anesthetic will be injected to numb the puncture site. The blood is injected with an epidural needle as accurately as possible into the vicinity of the leak. The blood coagulates or clots, forming a natural seal for the tear. A blood patch usually takes approximately thirty minutes to perform.

The majority of puncture headache patients experience relief straightaway after an epidural blood patch. There is a small number of cases (approximately 5%) in which a second injection is required to treat headache. Research demonstrates significant reduction of duration and intensity of headaches after a blood patch. This indicates the efficacy of this treatment for patients who have undergone a puncture and who suffer a headache as a result.

The advantage of the epidural blood patch procedure is that it is not time-consuming (see above) and is minimally invasive. There are some risks associated with the procedure, however. These are uncommon, but can include abdominal cramping, infection, bleeding, nerve damage, and failure of the procedure (i.e. continuation of the headache). Patients may also experience mild to moderate discomfort and pain for a number of days following a blood patch.

Conditions Related To an Epidural Blood Patch

Chronic HeadacheChronic daily headache is a common complaint, and not necessarily related to lumbar puncture. A physician will attempt to eliminate other possible causes of headache through patient interview and the use of brain imaging. Post-puncture headache is directly linked to a history of requiring injections into the spine, to treat or diagnose a painful condition. Some of these applications include epidural anesthesia, commonly administered during labor, a discogram or myleogram, in which diagnostic dyes are injected into the spinal cord area to visualize disorders or conditions, surgical anesthesia, and epidural injections to manage chronic pain.

Patients who have undergone any of these procedures, and consequently report chronic headaches, may do so due to a persistent lack of CSF from a leak into the epidural space. A CSF loss of only about 10% can result in a headache. Post-puncture headache is the subject of extensive research. One recent study reported that post-dural puncture headaches occur in up to 86% of patients who have received epidural injections.

The International Headache Society has categorized this type of headache as one that occurs seven days or less after a puncture or injection and is exacerbated by sitting upright for 15 minutes or less. The headache may improve after about 30 minutes spent in a supine or prone position. A post-dural headache may be accompanied by symptoms such as nausea, vomiting, and neck stiffness. The risks of developing a post-dural puncture headache are increased in those 18 and 30 years of age and in women who have received epidural pain-blocking injections while pregnant.

Epidural blood patch is associated with significant relief from puncture headaches caused by epidural injections. Recent studies have investigated its effects on post-dural headaches following different interventions, e.g. spinal fusion and intrathecal pain pump implantation. A report was published detailing some success with an epidural blood patch in a patient with headaches related to both of these procedures.

The procedure can also apparently correct other effects of post-dural puncture aside from headache. Another report, in the Journal of Pain Medicine, demonstrated an effect on post-puncture vertigo. According to this study, the patient exhibited vertigo in response to an epidural injection. An epidural blood patch procedure resulted in the reversal of this symptom.

Conclusion

An epidural blood patch is associated with significant and effective relief from a headache caused by injections into the spine. It is a gold-standard treatment for these post-dural puncture headaches. It is a minimally invasive option that often requires only one injection to seal cerebrospinal fluid leaks caused by lumbar puncture, and treat the concomitant chronic headaches.

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References

  1. Ahmed G, Arjang K, Mangar D. Post-dural puncture headache. Int J Gen Med. 2012;5:45-51.
  2. 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.
  3. 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.
  4. Madsen S, Fomsgaard J, Jensen R. Epidural blood patch refractory low CSF pressure headache: a pilot study. J Headache Pain. 2011;12:453-457.
  5. 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.
  6. Vazquez R, Johnson D, Ahmed S. Case Report – Epidural blood patch for postdural puncture position vertigo. Pain Medicine. 2011;12:148-151.