Treatment usually begins conservatively – with strict bed rest, increased fluid intake, and caffeine (either in drink form or by pill). If this cautious approach fails to result in closure of the hole, an epidural "blood patch" may be performed. In this procedure, a syringe of the patient’s own blood is removed from a vein and injected into the spine, either at the exact site of the leak or at a safe location in the low back. Often a blood patch results in rapid plugging of the hole and near immediate relief of symptoms. This procedure may need to be repeated a few times to be successful.

If the exact site of the leak is known, an interventional radiologist can sometimes "glue" the hole using a needle under x-ray guidance. Sometimes a neurosurgeon is needed to repair larger tears found in the spine, or a neurosurgeon or otolaryngologist (ENT) is needed to fix leaks inside the skull.

Our Hopkins anesthesiologists and pain specialists can perform the epidural blood patches. We work closely with neurosurgeons and otolaryngologists who can perform surgical repairs, and we also have world-class interventional neuroradiologists who can perform targeted gluing of leaks under x-ray guidance.