Low pressure headaches happen when the pressure or volume of cerebrospinal fluid (CSF), the fluid that cushions the brain and spinal cord, falls. This is usually because fluid is leaking through a small tear in the membrane that surrounds the spinal cord (the dura). When you are upright, the brain sags slightly and pulls on pain-sensitive structures, which causes the headache.1
A leak can follow a lumbar puncture, an epidural or spinal anaesthetic, spinal surgery or an injury. It can also happen without any clear cause, which is called spontaneous intracranial hypotension.12
The key feature is a headache that changes with position:
If the problem continues for a long time, the headache may become less dependent on position.1
Common causes include:
Go to the nearest emergency department.
Please see a doctor if you have a new headache, or a change in your usual headaches, especially if it is frequent, begins after the age of 50 or interferes with your daily life.
It is worth seeing a pain specialist if your headache clearly changes with posture, if it started after a lumbar puncture, epidural or spinal surgery, or if it has not settled after a few days of rest, fluids and caffeine.
Dr Liu will ask when the headache started, how it changes with position and whether you have had a recent spinal procedure, and will examine you. A headache that is worse upright should prompt doctors to consider low CSF pressure.1
The first scan is usually an MRI of the brain with contrast and of the whole spine.1 If the cause is still unclear, further tests such as CT myelography can help to locate a leak, and a lumbar puncture is sometimes used to measure CSF pressure.
Treatment depends on the cause and how severe your symptoms are.
Dr Liu will explain which option may suit you, including the benefits and risks.
Many people notice their headache improve after treatment, and some need more than one patch. After a patch you will be advised on rest and activity, and on warning signs to look out for. We will see you for follow-up, and we will plan any further treatment with you if it is needed. We want to help you get back to your daily life.
MOH accredited Pain Specialist and Medical Director of Alleviate Pain Clinic at Farrer Park Hospital. He completed an interventional pain fellowship at the University Health Network in Toronto and was previously a Senior Consultant in Pain Medicine at Singapore General Hospital.
Read more about Dr LiuThis page gives general information and is not a substitute for medical advice. Please see a doctor about your own symptoms and treatment options.
A low pressure headache is typically worse when you are upright and eases when you lie flat, and it often comes with neck pain or muffled hearing. A migraine is usually a throbbing headache with nausea or sensitivity to light and sound, and it is not mainly driven by posture. They can overlap, so an assessment helps tell them apart.
Some do, especially after a lumbar puncture or epidural, and they often settle over a few days with lying flat, fluids and caffeine. Headaches from a spontaneous leak may continue and need treatment. Please see a doctor if your headache is severe or is not settling.
It is a procedure in which a small amount of your own blood is injected into the epidural space, the space around the spinal cord. The blood forms a clot that helps to seal the leak and restore the pressure around the brain and spinal cord.
It is generally well tolerated and is done with local anaesthetic. Back ache or a feeling of pressure afterwards is common. Uncommon risks include infection, bleeding and nerve irritation. Dr Liu will explain the risks and what to expect before you decide.
A scan is usually needed. The first test is an MRI of the brain with contrast and of the whole spine. If the cause is still unclear, further tests such as CT myelography may be used to find the leak.
Interventional pain procedures are covered by the Ministry of Health's Table of Surgical Procedures (TOSP). They are therefore reimbursable by all Integrated Shield Plans and most corporate insurance plans. However, it is advisable to obtain preauthorisation from your insurer before the procedure. Our clinic staff will guide you through this process.
Effective pain solutions for a better living. Specialist pain management at Farrer Park Hospital, Singapore.
1 Farrer Park Station Road #08-14
Farrer Park Hospital (Connexion)
Singapore 217562
Mon–Fri 9am–5pm
Sat 9am–1pm · By appointment
