Post-spinal headache after surgery: would you go to A&E today?

[Fivegates]

I had surgery on Friday morning, it was a urology procedure but they did a spinal before my general anaesthetic.

Since yesterday morning I have a bad headache when standing up and my ears are ringing and muffled. I think it may be a post dural puncture headache as laying down gives relief.

Would you go to A&E for this or wait to see if it resolves? All info I can find is for pregnant women suggesting they go back to the maternity ward and I’m worried a hospital won’t have enough staff to do a blood patch today anyway.

I would call 111 and ask their advice. Or use their online symptoms checker. Don't present at A&E unless they recommend it.

They can last up to a week or so,I’d keep flat as long as possible and drink caffeine and maybe ring 111 or the ward for some advice.

Personally I would go to a&e, as it does sound like a spinal headache and you would need to see an anaesthetist, which a&e can sort out. (I work on a surgical ward).

But if you have the number of the ward you were discharged from, and if they are open at weekends, do try phoning that ward first for advice.

I don’t think phoning the maternity ward would be useful.

I’m not going to phone the maternity ward, just that all advice online seems to point to women that have had epidurals or spinals in labour. The ward I was on isn’t open at the weekend. Do you think it’s safe to wait for tomorrow to go to A&E?

with tinnitus, yes I would get medical advice today. There should be contact info in your discharge stuff but if not then 111 might be an option (if they can come up with a sensible plan quickly) or ED. Often a blood patch isn't done for 24-48 hours because it's more likely to work when it's done later, but when there is tinnitus/double vision/other cranial nerve signs then it is sometimes doing it sooner is better. Occasionally though it isn't a pdph and they need to think about the other causes of headaches that can cause weird signs. In the meantime, simple painkillers, really good hydration and rest can help, but I wouldn't wait til monday to speak to someone. (DOI: anaesthetist)

10-HeadachesSpinalEpiduralweb.pdf

Here’s the Royal College of Anaesthetists advice sheet op

https://www.rcoa.ac.uk/patients/patient-information-resources/anaesthesia-risk/headache-after-spinal-or-epidural-anaesthetic

Thank you I spoke to 111 and my gp, not sure how helpful it was but they’ve said to wait until Monday as actually when I got up and about to go to see them my headache cleared a bit and my hearing has too. If it’s still bad tomorrow I’ll go back to A&E where I had the op done. I’m extremely dehydrated and haven’t eaten much for days which they also said wouldn’t help a headache. I’ve been through a huge ordeal and couldn’t stop crying yesterday which also gives me a headache. Had a caserean in December, ureter was cut, had nephrostomy since Jan, been dealing with issues with that and infection all this time. Finally have had the reconstruction for my ureter and now dealing with the stent and catheter. A headache was the final straw!

@Greybeardy i still have an awful headache from this. I went to A&E yesterday and spent the whole day there only to be told that I need to give it sometimes 2 weeks to heal. It sounded like it’s too difficult to arrange a blood patch as I had an urology surgery not maternity. Is this safe advice? The tinnitus has calmed down but I’m getting so fed up of not being listened to.

no one on here can give you specific advice - the anaesthetics department that looked after you will have the info needed to advise you so if that's what they've suggested you kind of need to go with that or get back in touch with them. The reason more women get blood patches in obstetrics is that they're usually after epidurals and those are much less likely to heal than after a spinal. Spinals are more likely to heal by themselves and that can take time but sometimes they do need a blood patch and how long to wait/what's safe is a case-by-case decision usually involving the anaesthetist (+/- neuro as necessary). Remember a blood patch is an epidural, so also comes with a 1:100 chance of causing a PDPH as well as some other funky side effects and isn't something done lightly. Get back in touch with the anaesthetics department though if you're still worried.

They are unlikely to do a blood patch acutely - most low pressure headaches will resolve with fluids and painkillers (avoid codeine). You really need to keep up the fluids - if they did admit you the first line treatment would be iv fluids.

timing a blood patch depends very much on the details....none of which any of us really have. Sometimes we do do them after a few days, sometimes waiting longer's more sensible. IV fluids also aren't necessarily needed if patients can drink a reasonable amount (there's nothing magical about IV).

The headache has lifted a lot today. Mainly my frustration was from the lack of communication and difficulty getting any advice from the ward I was discharged from - they refused to pass me on for anaesthetist review when I called multiple times - I ended up in A&E all day Wednesday and saw a general registrar who advised keeping up with the fluids. I drink loads as I have a catheter and before this had a nephrostomy!