What is Epidural Blood Patch?
During an epidural blood patch, patients receive an injection of blood into the epidural space. First reported in 1960, this outpatient procedure is used to treat patients with chronic post-dural puncture headaches (spinal headaches), which are often caused by cerebrospinal fluid leakage. Studies have shown that post-dural puncture headaches are common in approximately 10% to 40% of people who have had lumber punctures for certain medical conditions.
The cerebrospinal fluid is located in a sac known as the epidural space. This fluid travels through the spinal cord and into the brain. When it leaks out of this area, it causes pressure in the brain to decrease. The epidural blood patch seals the leak and restores normal pressure in the brain.
How is Epidural Blood Patch Performed?
Prior to the procedure, approximately 15 to 20 mls of blood will be drawn that will later be used to inject into the area of the cerebrospinal fluid leak. Patients will then receive an injection of a local numbing anesthetic at the area of the spinal leak. An epidural needle is then used to inject the blood that was drawn into the target area. The blood eventually clots and seals the hole responsible for the leak. The procedure typically takes about 30 minutes.
In most cases, the relief felt from the epidural blood patch procedure is immediate. In some cases, it may need to be performed a second time; however, this only occurs in about 5% of patients. One recent pilot study published in the Journal of Headache and Pain showed a significant reduction of both intensity and duration of headaches in patients who underwent the epidural blood patch procedure. Researchers in this, and several other studies, have concluded that the epidural blood patch procedure remains a viable treatment option for patients suffering from post-dural puncture headaches.
The epidural blood patch procedure is minimally invasive; however, as with all procedures, there is still a risk of complications. Although rare, potential complications include infection, bleeding, abdominal cramping, headaches, and nerve damage. Patients may also experience some pain and discomfort for a couple days following the procedure.
Conditions Related to Epidural Blood Patch
Many people suffer from chronic daily headaches, which can be caused by a whole host of reasons. During patient assessment, clinicians attempt to identify the primary cause of pain through careful screening and imaging studies. One such cause, known as a post-dural puncture headache, should be considered in people that have a history of previous injections into the spinal column. Doctors perform these injections into the spinal column for a variety of reasons, which include:
- Epidural during labor
- Myelogram (contrast injected into the spinal cord area to examine the spinal canal)
- Surgical spinal anesthesia
- Pain management epidural injection
People who have had any of the aforementioned procedures and suffer from chronic headaches may be suffering due to the persistent leak of spinal fluid into the epidural area. It only takes about a 10% loss of fluid to cause a headache. These post-dural puncture headaches have been the subject of numerous studies. One study recently published in the International Journal of General Medicine reported that post-dural puncture headaches occur in approximately 16% to 86% of people who have had past epidural injections with large bore needles.
The International Headache Society has classified post-dural puncture headaches as a headache that occurs less than seven days after a spinal puncture and becomes worse after sitting upright for a period of less than 15 minutes. The headache often improves about 30 minutes after lying down. Symptoms that may accompany a post-dural headache are neck stiffness, nausea, and vomiting. The incidence is highest among people between 18 and 30 years of age and women who have received epidural pain blocks during pregnancy.
There has been a wealth of literature that designates the epidural blood patch as the gold standard for pain management for post-dural puncture headaches caused by lumbar injections. However, recent studies have also investigated its efficacy for treating patients who have developed post-dural headaches from surgeries such as intrathecal pain pump implantation and spinal fusion. One recent case report revealed a successful outcome regarding the use of an epidural blood patch for a patient who had been experiencing post-dural headaches related to spinal fusion and pain pump implantation.
Another recent case report published in the Journal of Pain Medicine showed favorable results after clinicians treated post-dural puncture vertigo with epidural blood patch treatment. During the example presented in this case study, the patient exhibited vertigo without having any symptoms of headaches. After receiving the epidural blood patch for the post-dural puncture-associated dizziness, all vertigo-related symptoms vanished.
Once the cause of an individual’s headache is determined to be from a post-dural puncture, the epidural blood patch remains a leading option to help alleviate pain. It is a minimally invasive option for those that suffer from debilitating post-dural puncture headaches.