Most pregnant people spend at least a little time thinking about, planning, and worrying about their baby's birth. It's natural to want to weigh your options for pain management during labor and delivery during that process. If you are considering an epidural, you may have heard that there are risks, but can an epidural cause headaches? It's always important to weight the pros and cons of any medical intervention before agreeing to it, especially when you're about to go through something as physically and mentally demanding as labor and delivery.
While the Mayo Clinic does list headaches as a potential side effect of epidurals, they are pretty rare. In fact, a large study of over 80,000 women who received epidurals during labor found that headaches only happen in less than one percent of women. Similarly, a Cochrane Review of research on pain management during labor found that having an epidural didn't increase women's risk of a post-labor headache, either. So, while it's possible to get a headache from your epidural, it's probably not something you should stress about, lest you give yourself a tension headache in the process.
According to Mayo Clinic, a spinal headache or post-dural puncture headache can occur after getting an epidural, but is the result of an anesthesiologist accidentally making a hole in the dura — or membrane —that surrounds the spinal cord and keeps spinal fluid where it belongs. A correctly administered epidural should not give you a headache.
During an epidural, your anesthesiologist inserts a needle and catheter to administer anesthetic medication into the area near your spine. There is a small risk that they might go too far and puncture the dura — also called a "wet tap." Because this can cause a small amount of your spinal fluid to leak out, and can in turn change the pressure in your brain and around your spinal cord, you can end up with a raging headache.
According to the Australian and New Zealand College of Anesthetists (ANZCA), a "wet tap" only happens in about one percent of epidurals, and a headache only results from about about 50 percent of those, or half of one percent of epidural procedures.
Another large study of 83,786 birthing mothers receiving epidurals, presented at the annual meeting of the American Society of Anesthesiologists, found that while doctors frequently warn laboring women of the risk of headaches following an epidural, they're actually really rare, impacting only 0.19 percent of the patients studied. Similarly, a systemic review of 40 studies including 11,000 patients concluded that there was no increased risk of headaches for women who got an epidural during labor versus other pain management.
ANZCA also warns moms-to-be that not all headaches that happen after delivery are related to having an epidural. Because dangerous conditions like postpartum preeclampsia, dehydration, and blood loss can also cause headaches, it's definitely not a symptom that should be dismissed, especially if accompanied by other symptoms or doesn't go away on its own. If you do have a headache following an epidural, you should tell your nurse or doctor right away.
According to the American College of Obstetrics and Gynecology (ACOG), most spinal headaches occur within 48 hours following birth, and resolve on their own without treatment. In the rare situation where treatment is needed, your doctor might administer fluids, caffeine (yes, caffeine), or pain medications to treat your headache. If necessary, they can also treat your headache with a special procedure called a blood patch, where they inject a small amount of your blood into the epidural catheter, which will then clot and form a patch on the hole in your dura.
So, if you want an epidural you probably shouldn't let the fear of a headache hold you back. While it's possible that your epidural can cause a headache, it's not likely.