How Long Does a Lidocaine Headache Last? Understanding Post-Procedure Headaches

October 9, 2025 •

5 min read

As many as 25% of people who undergo a lumbar puncture develop a post-dural puncture headache (PDPH), which can be mistaken for a lidocaine headache because the anesthetic is used during the procedure. While the medication itself rarely causes a lasting headache, the procedure can lead to a significant, positional head pain that requires specific care.

Quick Summary

A severe, positional headache following a procedure where lidocaine was used is likely a post-dural puncture headache (PDPH). This headache is caused by cerebrospinal fluid leakage and typically resolves within a week, though it can sometimes last longer.

Key Points

A 'lidocaine headache' is typically a misnomer: The headache is a complication of the procedure (like a spinal tap), not the lidocaine anesthetic itself, which has a short duration of action.
The primary cause is cerebrospinal fluid (CSF) leakage: A dural puncture during a lumbar puncture or epidural can cause CSF to leak, leading to a drop in pressure around the brain.
The defining feature of a PDPH is its positional nature: The headache intensifies when sitting or standing and subsides when lying down.
PDPH duration can range from days to weeks: The headache often resolves spontaneously within 6 weeks, but for severe cases, an epidural blood patch can provide quick and effective relief.
Risk factors include needle size, age, and BMI: Smaller needles, older age (though paradoxically, young women are also at risk), and lower BMI can reduce the risk of a PDPH.
Conservative treatment involves hydration and caffeine: For mild cases, drinking fluids, including caffeinated drinks, and bed rest can help manage symptoms.
An epidural blood patch is the definitive treatment: This procedure involves injecting the patient's own blood into the epidural space to patch the CSF leak.

The Misnomer of a “Lidocaine Headache”

It's a common misconception that the local anesthetic lidocaine is the direct cause of a persistent headache experienced after a procedure. In reality, lidocaine is a local anesthetic with a short half-life, meaning its numbing effects wear off relatively quickly, usually within a couple of hours. A lasting headache is not a typical side effect of the drug itself when used for local anesthesia, but rather a complication of the procedure it was used for, most notably a lumbar puncture or a spinal/epidural anesthetic injection. The headache is a specific type called a post-dural puncture headache (PDPH), and its duration is related to the cerebrospinal fluid (CSF) leak, not the medication.

Understanding Post-Dural Puncture Headaches (PDPH)

When a needle is inserted into the epidural space, a 'dural puncture' can occur, where the needle goes slightly too far and punctures the dura, the outer membrane of the spinal cord. This can also happen intentionally during a lumbar puncture, or spinal tap. The puncture causes a slow leakage of cerebrospinal fluid, which decreases the pressure of the fluid surrounding the brain. This reduced pressure allows the brain to 'sag,' stretching the sensitive nerves and blood vessels in the brain's meninges (the surrounding membranes), leading to a headache.

The most distinctive feature of a PDPH is its positional nature: the headache worsens when sitting or standing and improves significantly, or disappears entirely, when lying down.

How Long Does a Lidocaine Headache Last? The Typical Duration of a PDPH

The duration of a PDPH can vary greatly among individuals, depending on various factors. For many people, the headache will resolve on its own, but it can be debilitating while it persists. Here's what the timeline typically looks like:

Onset: The headache often begins between 24 and 72 hours after the procedure but can occur earlier or later.
Spontaneous Resolution: Without any intervention, about 85% of PDPH cases will resolve on their own within about 6 weeks. However, many people find the symptoms too disruptive to wait that long, especially new mothers following childbirth.
Treatment with a Blood Patch: For severe or persistent cases, an epidural blood patch can offer immediate and effective relief. The success rate is high, with around 60% to 70% of people experiencing relief within 24 hours of the procedure. If the headache recurs, a second blood patch may be required.

Factors Influencing PDPH Duration and Severity

Several factors can influence the likelihood of a PDPH developing and how long it lasts. These include:

Needle Size and Type: Smaller, non-cutting or 'pencil-point' needles are less likely to cause a fluid leak than larger or cutting-edge needles.
Number of Puncture Attempts: Multiple attempts to perform the procedure increase the risk of a dural puncture.
Patient Age: Younger patients, particularly those between 20 and 40 years old, and pregnant women are at a higher risk.
Body Mass Index (BMI): Research suggests that patients with a higher BMI may be more prone to PDPH.
Patient History: A history of previous headaches or migraines can increase the risk of developing a PDPH.

Comparison of Post-Procedure Headaches

While a PDPH is the most common and likely culprit, other types of headaches can occur after a medical procedure. Here’s a comparison:


Feature	Post-Dural Puncture Headache (PDPH)	Muscle Tension Headache	Caffeine Withdrawal Headache
Cause	Leakage of cerebrospinal fluid following dural puncture.	Muscle contractions in the neck, head, and scalp due to stress or procedural positioning.	Abrupt cessation of daily caffeine intake.
Primary Symptom	Severe, throbbing, or dull pain that is positional; worse when upright, better when lying down.	Tight, pressing band-like sensation around the head; non-positional.	Diffuse, throbbing pain that is constant and may feel similar to a migraine.
Onset	Typically within 24-72 hours after the procedure.	Can occur anytime after the procedure, often related to stress.	Occurs when caffeine is withheld for 12-24 hours.
Associated Symptoms	Nausea, vomiting, stiff neck, dizziness, hearing changes, visual disturbances.	Neck stiffness, scalp tenderness.	Fatigue, nausea, irritability.
Treatment	Conservative care (hydration, caffeine, bed rest), epidural blood patch for persistent cases.	Over-the-counter pain relievers, rest, cold/warm compress.	Reintroducing caffeine or gradually reducing intake; OTC pain relievers.

When Lidocaine Infusions Can Cause Headaches

In some specialized pain management settings, lidocaine is administered intravenously to treat severe, refractory headaches. In these cases, the medication itself can sometimes cause temporary side effects, including a headache. However, these are generally short-lived and resolve once the infusion is complete or within the first day, unlike a PDPH.

Treatment Options for Persistent Post-Procedure Headaches

If you experience a severe or persistent headache after a procedure involving lidocaine, it is crucial to consult your healthcare provider to confirm the cause and determine the best course of action. Treatment options range from supportive care to definitive intervention:

Conservative Management: For mild to moderate cases, initial treatment often involves bed rest, staying well-hydrated, and consuming caffeinated beverages (unless contraindicated). Caffeine helps to constrict cerebral blood vessels, which can alleviate the low-pressure headache. Over-the-counter pain relievers like acetaminophen or ibuprofen may also provide some relief.
Epidural Blood Patch (EBP): Considered the 'gold standard' for severe, persistent PDPH, this procedure involves drawing a small amount of your blood and injecting it into the epidural space. The blood clots and seals the leak in the dura, restoring the CSF pressure and often providing rapid symptom relief.

Conclusion

While a lasting headache is rarely caused directly by the anesthetic lidocaine, it is a well-documented complication of procedures like spinal taps and epidurals where lidocaine is used. The resulting post-dural puncture headache is positional and can last from a few days to several weeks, though most cases resolve spontaneously within that timeframe. The duration and severity are influenced by factors like needle size, patient age, and the number of puncture attempts. For persistent or severe headaches, effective treatments like the epidural blood patch are available. Anyone experiencing a debilitating or lasting post-procedure headache should consult a medical professional for proper diagnosis and care.

For more information on spinal headaches and related treatments, consult reputable medical sources such as the Cleveland Clinic.

Frequently Asked Questions

A post-dural puncture headache (PDPH) is a severe headache that occurs after a medical procedure that involves a puncture of the dura, the membrane surrounding the spinal cord. This causes cerebrospinal fluid (CSF) to leak, reducing the pressure around the brain and causing a headache.

Lidocaine itself does not cause persistent headaches in most typical applications. It is a short-acting anesthetic. Headaches that people associate with lidocaine are almost always post-dural puncture headaches (PDPH) resulting from the procedure during which the anesthetic was used.

The most defining feature of a PDPH is its positional nature. The pain worsens significantly when you sit or stand and improves or disappears when you lie down.

With no intervention, about 85% of PDPH cases will resolve spontaneously within approximately 6 weeks. The onset is typically within 24 to 72 hours of the dural puncture.

You should contact your healthcare provider if you have a severe headache after a procedure involving a spinal injection, especially if it persists for more than 24 hours. Immediate medical attention is necessary if you experience other symptoms like fever, neck stiffness, numbness, or loss of bladder control.

An epidural blood patch is a procedure that involves injecting a small amount of your own blood into the epidural space to create a clot that seals the hole in the dura. Relief from the headache can be immediate and often permanent, though sometimes a second patch is needed.

Yes, caffeine can be an effective component of conservative treatment for a PDPH. It helps constrict cerebral blood vessels, which can alleviate the low-pressure headache.