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Headache after lumbar puncture is a common occurrence and have a benign course in the majority. In rare cases, it can be a manifestation of rare but potentially life-threatening intracranial complications. We discuss a case of 65 years male patient who was operated for left inguinal hernia under spinal anaesthesia, had persistent headache partial response to conservative measures developed one episode of seizures and lapsed into altered sensorium. Imaging findings were suggestive of extensive left frontal-temporoparietal acute SDH with mass effect and midline shift. The hematoma was evacuated and the patient recovered well. Prolonged and persistent post-dural puncture headache complicated by atypical neurological deterioration following spinal anaesthesia should prompt the physician to consider the possibility of intracranial complications and to seek immediate radiological investigations.