Spinal headache after an epidural: the signs to know

You finally have your baby in your arms. Then, a day or two later, you sit up to feed them and a headache hits so hard you have to lie back down. Lying flat, it eases. Sit up again, and it’s back. If that sounds familiar, you may be dealing with a spinal headache.

A spinal headache, called a post-dural puncture headache by doctors, is an uncommon but well-known side effect of an epidural or spinal. It’s not dangerous in most cases, it’s treatable, and you don’t have to just push through it. But it’s also something many new moms have never heard of until it happens to them.

This post explains what a spinal headache is, the signs to look for, the “lie-down” clue that sets it apart, how it’s treated and, most importantly, when a headache after birth means you should get care right away. We’re a fitness and community brand, not doctors, so think of this as a guide to help you recognize what’s happening and talk to your care team, not as medical advice.

What a spinal headache is

Your brain and spinal cord sit in a sac of fluid called cerebrospinal fluid, surrounded by a thin membrane called the dura. An epidural is placed just outside the dura. Occasionally, the needle goes a tiny bit too far and makes a small hole in it. A spinal anesthetic, often used for C-sections, goes through the dura on purpose with a very fine needle.

If fluid leaks out through that small hole, the pressure around your brain drops. According to the Royal College of Anaesthetists, that lower pressure is what causes the headache, and sitting or standing up lowers it even more, which is why the pain gets worse when you’re upright.

You’ll hear it called a few different names: post-dural puncture headache (PDPH), spinal headache, epidural headache or low-pressure headache. They all describe the same thing.

Why it happens

It’s important to say this clearly: a spinal headache doesn’t mean anyone did something careless. Placing an epidural is precise work, often done while you’re mid-contraction and doing your best to hold still. Small accidental punctures are a known risk even with experienced anesthesiologists.

The Royal College of Anaesthetists notes that young people and women having an epidural or spinal for childbirth are more likely than other patients to get this kind of headache. So if it happens to you, you’re in a group that anesthesia teams know well, and they have a clear plan for treating it.

How common it is

Spinal headaches are uncommon. The Royal College of Anaesthetists puts the risk at between 1 in 100 and 1 in 500 epidurals or spinals. A ten-year study of more than 32,000 obstetric patients at one U.S. medical center found that just under 1% developed one.

That means most moms who have an epidural will never get a spinal headache. But because so many women have epidurals, a lot of new moms do experience one, and it helps to know the signs ahead of time.

Why you might not hear about it beforehand

Many women say nobody mentioned spinal headaches before their epidural, or that it was one quick line in a long consent conversation during labor. That’s understandable. It’s hard to absorb anything in the middle of contractions. It’s one reason we think it’s worth writing about now, so that you, your partner and the people helping you at home can spot it quickly and get the right care. If you’re still pregnant and reading this, it’s a great question to ask at a prenatal visit or a hospital tour: “What should I watch for after an epidural, and who should I call?”

The signs to know

A spinal headache usually starts within a day or two of the epidural or spinal. Typical onset is 24 to 48 hours after the puncture, and the Royal College of Anaesthetists says it’s most likely to start between one day and one week afterward. It often doesn’t show up until you’re home or getting up more.

1. 🪑
   The big oneWorse sitting or standing

   The headache gets noticeably worse within minutes of sitting up or standing, and eases when you lie flat.

2. 🧠
   LocationFront or back of the head

   Often felt across the forehead or at the back of the head, sometimes spreading down into the neck and shoulders.

3. 💆‍♀️
   NeckStiff, sore neck

   Many women notice neck pain or stiffness along with the headache.

4. 🤢
   StomachNausea

   Feeling sick or throwing up, especially when upright.

5. 🕶️
   EyesBright light bothers you

   Sensitivity to light, and sometimes blurry or double vision.

6. 👂
   EarsRinging or muffled hearing

   Ringing in the ears, muffled hearing or feeling slightly dizzy.

Many women describe it as the worst headache they’ve ever had, or like a severe migraine that gets worse every time they sit up. Some say it feels like their head is too heavy to hold up. Coughing, sneezing or straining can make it worse too.

The lie-down clue

The single most telling feature of a spinal headache is what happens when you change position. The Cleveland Clinic describes this kind of positional headache as one that gets worse when you sit or stand and better when you lie down.

In practice, it often looks like this:

• You wake up feeling okay or only mildly achy.
• Within about fifteen minutes of sitting up or standing, the pain builds, often sharply.
• When you lie flat again, it eases noticeably, sometimes within minutes.
• As the day goes on and you spend more time upright, it gets worse.

If you notice that pattern after an epidural or spinal, call your provider or the hospital where you gave birth and tell them. It’s exactly the information they need.

Other postpartum headaches

Headaches after birth are common, and most aren’t spinal headaches. A patient guide from The Ottawa Hospital lists many everyday causes: lack of sleep, your milk coming in, not eating enough, tension and more. These usually feel different from a spinal headache because they don’t change much when you lie down.

Some other common culprits:

• Exhaustion and dehydration. Broken sleep and forgetting to drink water are classic headache triggers.
• Tension. Hours of feeding and holding a baby with hunched shoulders can tighten your neck and upper back.
• Hormone shifts. Hormone levels change quickly after birth, and some women get migraines.
• Caffeine changes. Drinking more or less coffee than usual can bring on a headache.

But because some headaches after birth are serious, it’s never wrong to call your provider about a headache that worries you. Which brings us to the most important section of this post.

When to get care right away

The CDC’s Hear Her campaign lists urgent maternal warning signs that need medical care right away, during pregnancy and for up to a year after birth. A headache is one of them. Get care immediately if you have a headache that:

• Won’t go away or gets worse over time
• Feels like the worst headache of your life
• Doesn’t improve with medicine and fluids
• Starts suddenly with severe pain, like a clap of thunder

Also get care right away if a headache comes with any of these: changes in your vision, dizziness or fainting, a fever, a seizure, confusion or unusual drowsiness, trouble breathing, chest pain, or extreme swelling of your hands or face. These can be signs of serious conditions, including high blood pressure problems like postpartum preeclampsia, which can develop after birth even if your pregnancy was healthy.

The Ottawa Hospital’s guide also advises contacting your care team if you have a severe headache that does not get better when you lie down, especially with a fever or drowsiness.

What to tell your provider

When you call, it helps to have a few details ready. You can read this list straight off your phone:

1. When you gave birth and whether you had an epidural, a spinal or both.
2. When the headache started.
3. Where it hurts and how bad it is, on a scale of 1 to 10.
4. Whether it changes with position. Worse sitting or standing, better lying flat?
5. Any other symptoms: neck stiffness, nausea, vision or hearing changes, fever, swelling.
6. What you’ve tried and whether it helped.
7. Your blood pressure, if you have a home monitor.

How it’s treated

The good news: spinal headaches usually get better. The hole in the dura typically heals on its own, and there are effective treatments to help in the meantime. Your anesthesia team will talk through options with you, usually based on how severe your symptoms are and how much they’re affecting your daily life.

Conservative care

For milder headaches, care often starts with rest, fluids, caffeine and pain relief. The Ottawa Hospital’s guide lists lying down, drinking lots of fluids, caffeinated drinks like coffee or tea, and over-the-counter pain relievers as options, while noting that these ease the pain but don’t make the puncture heal faster. Always check with your provider about which medicines are right for you, especially if you’re breastfeeding.

An epidural blood patch

If the headache is severe, isn’t improving or is getting in the way of caring for yourself and your baby, your team may offer an epidural blood patch. The Royal College of Anaesthetists notes that this kind of headache is frequently treated this way, and it often brings fast relief.

What a blood patch is like

A blood patch sounds intimidating, but many women describe it as surprisingly quick. Here’s a general idea of what to expect. Your own care team will give you the details for your situation.

1. A little blood is drawn from your arm, much like a regular blood test.
2. That blood is injected into your back, into the same area where the epidural was placed. The idea is that it seals the small hole and stops the leak.
3. You lie flat afterward for a period your team recommends.
4. You take it easy for a while. Patient guides commonly advise avoiding straining and heavy lifting for a period afterward, other than your baby.

For many women, the headache improves quickly. Guides from the Cambridge University Hospitals and the Royal College of Anaesthetists note it’s common to have some backache or stiffness for a few days afterward, that a small number of people need a second patch, and that there’s a small chance of another accidental puncture. Your anesthesiologist will talk through the benefits and risks with you before you decide.

Getting through it at home

Whether you’re waiting for the headache to heal on its own or recovering from a blood patch, a few things can make the days easier.

1. 🛏️
   RestLie flat when you can

   Feed lying on your side, nap flat and let others do the walking and carrying while you recover.

2. 💧
   HydrateKeep drinking fluids

   Keep water within reach. Your care team may suggest drinks with caffeine, like coffee or tea, which many people find helpful.

3. 💊
   MedicineUse the pain relief you were given

   Take only the pain medicine your provider recommends, and ask which options are safe if you’re breastfeeding.

4. 👪
   HelpLet people take over

   Ask a partner, family member or friend to handle diaper changes, bouncing and errands for a few days.

5. 📝
   NotesTrack your symptoms

   Jot down when it started, how bad it is and what helps. It makes calls with your provider much easier.

6. 📞
   Follow upCall back if it’s not improving

   If it’s still there after a few days, or getting worse, call again. You’re not bothering anyone.

Feeding while lying down

If you’re breastfeeding, side-lying feeding can be a lifesaver during a spinal headache. If you’re bottle-feeding, a partner or helper can handle more feeds for a few days. A lactation consultant or nurse can show you safe positions for feeding while lying down, and help you plan for when you fall asleep.

Make your space lying-down friendly

Set up a recovery nest wherever you’re spending the most time flat: water and snacks within arm’s reach, a phone charger, burp cloths, diapers and wipes, a small lamp instead of overhead lights and a bassinet or safe sleep space for the baby close by. The less you need to get up, the better you’ll feel.

Asking for help is part of the treatment

A spinal headache can make it nearly impossible to do the upright, carrying, bouncing parts of new parenthood. That’s not a failure. It’s a medical reason to let other people step in. Make a list of what you need, and hand it to whoever offers.

For partners and family: how to help

If someone you love is dealing with a spinal headache after birth, your help can make a huge difference. A few ways to show up:

• Take the headache seriously. It isn’t “just a headache.” Help her call her provider, and go with her if she needs care.
• Learn the warning signs. The CDC’s Hear Her campaign encourages partners, family and friends to listen when a new mom says something doesn’t feel right and to help her get care.
• Take over the upright jobs. Diaper changes, bouncing, burping, walking the hallway at 2 a.m. and bringing the baby to her for feeds.
• Bring the essentials to her. Water, snacks, pain relief as directed, a phone charger and the baby.
• Protect her rest. Handle visitors, keep the room dim and quiet and let her sleep when the baby sleeps.
• Check on her mood. Ask how she’s feeling, not just how her head is. A hard start can take an emotional toll.

Getting back to normal afterward

Once your headache has cleared, you might be eager to make up for lost time. Go gently. Follow any instructions your anesthesia team gave you about lifting and straining, especially after a blood patch. Then ease back into walking and movement when your provider says it’s okay.

The Cambridge University Hospitals guide notes that epidurals don’t cause long-term backache. Some soreness or stiffness in your back for a few days after a blood patch is common, but if you have back pain that’s severe, getting worse, or comes with fever, numbness, weakness or trouble peeing, call your provider right away.

And give yourself credit. You recovered from birth and a spinal headache at the same time as caring for a newborn. That’s a lot. Whatever strength-building comes next, you’re starting from a place of real resilience.

When it takes the joy out

One of the hardest parts of a spinal headache is the timing. These are supposed to be the days of soaking in your baby, and instead you’re lying in the dark, unable to sit up. Many women describe feeling cheated, guilty or frustrated, and some feel like they’re missing those first days with their baby.

Those feelings are valid. If they linger, or you notice that sadness, anxiety or a sense of disconnection is hanging on for more than a couple of weeks, please talk to your provider. You can also call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), any time, for free, confidential support.

And when you’re feeling better, it can help to talk about what happened. Sharing your story with other moms who’ve been through a hard birth or recovery can make it feel less isolating.

If you’re planning another baby

If you’ve had a spinal headache before and you’re pregnant again, or thinking about it, tell your provider and the anesthesia team when you’re making your birth plan. They can talk you through your options for pain relief and what they’ll watch for. Having a spinal headache once doesn’t mean you can’t have an epidural again, but it’s a conversation worth having ahead of time.

If your delivery was tough

At Pink in Progress, our virtual nap-time circles are open to moms in every kind of recovery, including the lying-down kind. Cameras are optional, and nobody minds if you’re horizontal with the lights off. When you’re cleared and feeling more like yourself, our guide to postpartum exercise and our coaches can help you rebuild slowly, around your body and your birth.

And if you’re reading this while lying flat in a dim room, phone brightness turned all the way down: you’re doing a great job. Rest is not wasted time. It’s how you get back to the things you love.

For now, the most important thing is the simplest one. If you have a headache after birth that worries you, especially one that changes when you sit up, call someone today. You deserve to feel well enough to enjoy these days.

• Postpartum recovery
• New moms
• Epidurals
• Postpartum warning signs
• Birth recovery