Background: Dural puncture headache is a condition that occurs post-dural puncture headache (PDPH), especially in the context of cesarean delivery, and can affect the patient's comfort and mobility. In this study, we examined the effect of different spinal needle sizes on individuals undergoing surgical procedures. Objective: The objective of this study was to examine the impact of spinal anesthesia needle size on the incidence of postoperative headache. Method: In a cross-sectional descriptive study, we surveyed 100 patients who underwent spinal anesthesia. Participants were divided into two groups: Group A (with headache) and Group B (without headache). Their ages ranged from 20 to 82 years, and their weight varied between 50 and 115 kg. The study took place at both the Preventive Medicine Hospital (Maitika) and Al Zahraa Hospital between February and May 2024. Result: There was a statistically significant link between PDPH incidence with larger needle sizes, female sex and younger age. PDPH severity significant with average surgery time (p = 0.024). Patients with the longest surgery times (52.1 ± 4.39 minutes) reported the most severe headaches, the severe headaches only occurred with 22-gauge needles (100%). In contrast, 73.1% of 27-gauge needle users reported no headaches, compared to 25.0% of 25-gauge needle users. Conclusion: In our study, gender significantly influenced headache presence. Females experienced more headaches than males. Additionally, headache occurrence and severity correlated with surgery duration and anesthesia needle size. Longer surgeries were associated with more severe headaches, and larger needles increased the likelihood and severity of headaches.