I heard of a case where someone suffered severe migraines after a lumbar puncture.

There are two possible explanations. Firstly, the low CSF [cerebrospinal fluid] volume depletes the cushion of fluid supporting the brain and its sensitive meningeal vascular coverings, resulting in gravitational traction on the pain‐sensitive intracranial structures causing classical headache, which worsens when the patient is upright and is relieved on lying down [Hatfalvi, B. I. (1995)]. Secondly, the decrease in CSF volume may activate adenosine receptors directly, causing cerebral vasodilatation and stretching of pain‐sensitive cerebral structures, resulting in headache after lumbar puncture [Fearon, W. (1993)].

This made me wonder if it would be plausible that spinal problems such as spinal compression could cause migraines?

References

Fearon, W. (1993). Post-lumbar puncture headache. P&S Medical Review, 1, 1.

Hatfalvi, B. I. (1995). Postulated mechanisms for postdural puncture headache and review of laboratory models: clinical experience. Regional Anesthesia and Pain Medicine, 20(4), 329-336. PMID: 7577782

Linked article:

Ahmed, S. V., Jayawarna, C., & Jude, E. (2006). Post lumbar puncture headache: diagnosis and management. Postgraduate medical journal, 82(973), 713-716. doi: 10.1136/pgmj.2006.044792 PubMed Central Free Article: PMC2660496

  • The exact pathophysiology of headache after lumbar puncture is unclear. However, it is most probably related to the “hole” in the left dura after the needle has been withdrawn, resulting in persistent leak of CSF from the subarachnoid space. This leakage results in a fall in intracranial CSF volume and CSF pressure. Although the loss of CSF and lowering of CSF pressure is not disputed, the actual mechanism producing the headache after lumbar puncture is not clear. If this theory is valid, there should at least be a totally different pathophysiology for spinal compressions... – Narusan Dec 5 at 8:58
up vote 4 down vote accepted

The headache after lumbar puncture is common (~30%) and is not migraine headache. The mechanism is not entirely clear but likely involves a drop of cerebrospinal fluid volume and/or pressure (PubMed):

There are two possible explanations. Firstly, the low CSF [cerebrospinal fluid] volume depletes the cushion of fluid supporting the brain and its sensitive meningeal vascular coverings, resulting in gravitational traction on the pain‐sensitive intracranial structures causing classical headache, which worsens when the patient is upright and is relieved on lying down. Secondly, the decrease in CSF volume may activate adenosine receptors directly, causing cerebral vasodilatation and stretching of pain‐sensitive cerebral structures, resulting in headache after lumbar puncture.

Also:

According to the Headache Classification Committee of the International Headache Society, headache after lumbar puncture is defined as “bilateral headaches that develop within 7 days after an lumbar puncture and disappears within 14 days. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent position”. This definition helps to avoid confusion with migraine or simple headache after lumbar puncture.

A herniated disc that puts pressure on the spinal nerves or spinal cord in the neck (cervical spinal stenosis) can cause "cervicogenic headache." This headache is also not migraine headache and

is characterized by unilateral headache symptoms arising from the neck that radiate to the frontal-temporal and possibly to the supraorbital region.

Mechanism (StatPearls):

A cervicogenic headache is thought to be referred pain arising from irritation caused by cervical structures innervated by spinal nerves C1, C2, and C3.

A herniated disc or spinal stenosis in the thoracic, lumbar or sacral region as such does not likely cause headache, but it rarely can, if the disc cuts the dura mater and causes CFS leakage leading to spontaneous intracranial hypotension (PubMed).

I maybe jumped too much on the term "migraine," but I wanted to be accurate. The exact definitions of various types of headache are here: The International Classification of Headache Disorders, 3rd edition (2018).

  • Great answer. Just saw this after editing my question with a quote you put in your answer. Thanks for clearing up the migraine confusion. I totally understand the reason for clarification. – Chris Rogers Dec 5 at 9:42
  • I expanded the answer: herniated discs in thoracic, lumbar or sacral region does not likely cause headache. – Jan Dec 5 at 10:09
  • reading the PubMed article linked to your edit states that thoracic, lumbar or sacral compressions could cause spontaneous intracranial hypotension (SIH) which is "a rare condition presented with cardinal postural headache" – Chris Rogers Dec 5 at 10:16
  • Yes, and it says it is rare as I also put in my answer. Herniated discs in the regions other than cervical, rarely cause headaches, because they very rarely damage the dura mater to the point of CSF leakage. – Jan Dec 5 at 10:30
  • Thanks @Jan, I see that now. I slightly misread what you said. – Chris Rogers Dec 5 at 10:35

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