A 53-year-old female with history of multiple lumbar surgeries presented to the emergency department with a progressively worsening headache. She reported receiving an epidural injection for pain management of her low back pain days before her headache began. 

A low-pressure headache was suspected and was confirmed by a new finding of low-lying tonsils on MRI brain. She was treated with conservative medical management, yet her headache persisted. She underwent an epidural blood patch and developed significant muscle spasms and radiating pain. Subsequent MRI imaging of the lumbar spine revealed clumping of the nerve roots, indicative of arachnoiditis. She was treated with high dose steroids with a taper, opioids, amitriptyline, lamotrigine, and pregabalin without relief.