Friday, May 4, 2012

“Fun with Spinal Taps” or “Why I Had to Lie Flat on My Back All Week”

I'm sorry I didn't make my normal post this week. Here's what happened.

As I wrote about here, I am now receiving injections of a chemotherapy drug called methotrexate directly into my spinal cord. This is an experimental treatment for MS.

Sometimes when a doctor pierces the spinal cord with a needle, in order to either extract fluid for testing or inject medicine for treatment, the puncture that the needle leaves in the dural lining of the spinal cord does not completely and immediately close (or heal).

When this problem occurs, which is between 10% and 30% of the time with lumbar punctures (LPs), the ensuing leakage of spinal fluid causes a headache that can be severe when sitting up, but is usually mild when lying flat. I was lucky enough to experience an LP headache after my injection on Monday of this week, and it was rather debilitating.

I had to lie flat in bed or be completely reclined in my wheelchair from Monday of this week until today (Friday), except for a few uncomfortable instances where I had no alternative but to be upright for a few minutes.

Sometimes these LP headaches resolve themselves within a couple of days. If they don't, then the standard treatment is called a blood patch, which I received today.

In a nutshell, with a blood patch the doctor takes about 15 ml of blood out of an arm vein and injects that blood directly into your spinal cord, at about the same location as the original puncture. So I had the pleasure of enduring a second spinal tap this week to treat the side effects from the first spinal tap.

I'm happy to report that the blood patch procedure provided complete and immediate relief, as it does in about 90% of cases. I'm now sitting upright in my wheelchair, reading my e-mails and completing other tasks that were difficult to do while lying flat on my back.

And I quite look forward to once again eating peas at dinner without them ending up in my bed sheets.

Note for people who might undergo a spinal tap: I found a great article that describes in some detail why this post-lumbar puncture headache occurs, and discusses how it can be avoided and/or treated. Click here.

Note: To see all of my intrathecal methotrexate posts, click here. They are listed in reverse chronological order.


  1. Mitch, I'm sorry you had to endure that infuriating pain all week. Too bad they didn't do the blood patch on, say Wednesday! So, is this something you get to look forward to after 10% to 30% of your methotrexate treatments? Damn. I hope they work for you.

  2. Mitch, how soon will they know if this procedure is having any effect on the MS? I had 2 LPs, and with both, I had no problem. I had heard that caffeine helps with the headaches, so I had Excedrin and hot chocolate waiting for me. Good luck with the future treatments and keep us informed.

  3. Webster,

    I sure hope I don't have to go through this 10% to 30% of the time.


    They won't really tell me if this is having any effect on my MS. I'll pretty much have to tell them. I'm trying to withhold judgment for six months so that I don't confuse normal everyday variation with any actual long-term trends that may emerge.

  4. I believe the medical terminology for this is "Damned if you do; Damned if you don't." Hope this week is not repeated. Really sorry. Ginny and James

  5. Welcome back!

    I had one LP headache w/the 4 intrathecal methotrexate shots I had. It lasted 6 days.

    My dr couldn't do the blood patch in his office and sent me to the ER. They gave me a caffeine IV and told me to give it a few more days before scheduling the blood patch. The headache went away a few days later.

    I've probably had 10 LP's w/MS and it was the only headache I got. The dr also changed the needle tip from a serrated one, to a pointier one, to help.


  6. Ginny and James,

    thanks for your well wishes.


    I've have six LPs, and this was my second headache.

  7. Mitch,
    One of the things I like about you is that you always speak the truth. It's good to get the negative stuff summed up and bundled together--I think it makes it easier to get some binders on that way.

    Great post, as usual!