24 year old female with a PMH of morbid obesity (BMI 50), presenting for her first c-section. A decision was made for her to receive spinal anesthesia. There was marked difficulty in the spinal placement, requiring over 90 minutes with attempts by multiple experienced personnel. Eventually, there was successful placement with a 27G spinal needle through a 17G tuohy needle. The c-section was performed uneventfully. Our patient was discharged from the hospital 3 days after delivery without any signs of headache. Two days later, she woke up with a headache that was positional, worse with standing, and resolves while supine. She returned to the hospital and anesthesiology was consulted. The headache was almost entirely frontal, behind the eyes in a T shape. Treatment options were discussed with the patient. Due to the difficult neuraxial placement and because there was difficulty with IV placement, a blood patch would have been challenging, posing a risk for exacerbation of the headache. Around the clock acetaminophen and ibuprofen did not provide relief. Rest, IV hydration, caffeine, and oral analgesics were initially attempted without much success. Ultimately, a decision was made to administer neostigmine 20 μg/kg and atropine 10 μg/kg at bedside. After administration of these medications, her headache significantly improved within an hour, and she was seen standing comfortably in patient room. Patient's only experienced side effect was transient blurred vision.