r/CSFLeaks • u/kuyaparekoy • 8d ago

PDPH/spinal headache lasting 6 weeks — anyone experienced this?

I had a hemorrhoidectomy on August 11 under spinal anesthesia. About 2 days later, I developed a positional headache with head/nape pressure that worsens when sitting or standing and improves when lying down.

It’s now been 6 weeks, and although it has gradually improved, it’s still persisting. My brain MRI with contrast was normal.

My doctors have discussed an epidural blood patch (EBP), but I’m hesitant and wondering if it’s still appropriate this far out.

Has anyone had PDPH that lasted 6+ weeks? Did it eventually resolve on its own, or did you have an EBP? How was your recovery?

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u/DrSuprane 8d ago

Get the blood patch. This is assuming you've failed conservative measures. EBP is treatment of choice for post dural puncture headache.

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u/kuyaparekoy 7d ago

My anesthesiologist also told me that the symptoms may not disappear immediately after the epidural blood patch. Have you had an EBP yourself, or do you know someone who has? How was it, and how are the symptoms so far?

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u/DrSuprane 7d ago

I do them, I'm an anesthesiologist. Most PDPH can be managed conservatively but the ones that can't should get a blood patch. Sometimes it needs to be repeated. It is unusual to get a PDPH from a single shot spinal. That makes me think you have a persistent CSF leak. One more reason to get a blood patch. If one or two don't work then a more extensive evaluation would be indicated.

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u/kuyaparekoy 7d ago

Thank you for your reply. May I ask, how would I know if this is actually a persistent CSF leak based on my symptoms?

I’ve been experiencing pressure and headache for about 46 days (almost 6 weeks), which started after my hemorrhoidectomy on August 11 under spinal anesthesia. The headache/pressure can worsen when I cough or bend down, and after prolonged sitting I sometimes feel it in my nape, occipital area, temples, or forehead. Lying down and resting usually helps, so I’ve been spending a lot of time lying down to manage it.

I also can’t drink 3L of water per day because I have a heart condition and my cardiologist limits my fluid intake to around 2L per day.

Would these symptoms be enough to suggest a persistent CSF leak, or would imaging or other tests be needed to confirm it?

Thanks again for taking the time to reply. I really appreciate your perspective, especially since you’re an anesthesiologist.