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Postpartum headache: is your work-up complete?

Caroline L Stella1, Cristiano D Jodicke, Helen Y How

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.

American Journal of Obstetrics and Gynecology
|April 4, 2007
PubMed
Summary
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Postpartum headaches require careful, stepwise evaluation. Common causes include migraine and preeclampsia, but serious conditions like hemorrhage necessitate imaging for prompt diagnosis and treatment.

Area of Science:

  • Obstetrics and Gynecology
  • Neurology
  • Public Health

Background:

  • Postpartum headache is a frequent concern with limited data on causes and management.
  • Effective diagnostic and treatment strategies are crucial for maternal well-being.

Purpose of the Study:

  • To describe the experience with hospitalized postpartum headache patients.
  • To develop a management algorithm for postpartum headaches.

Main Methods:

  • Retrospective review of 95 women hospitalized for headache >24 hours postpartum (2000-2005).
  • Assessment included evaluation for preeclampsia, dural puncture, neurologic lesions, and cerebral imaging based on findings.
  • Outcomes: cause, need for imaging, neurologic findings, complications, and follow-up.

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Main Results:

  • Mean headache onset was 3.4 days postpartum. Common causes: tension-type/migraine (47%), preeclampsia/eclampsia (24%), spinal headache (16%).
  • Cerebral imaging in 22 patients revealed abnormalities in 68%, including 10 serious pathologies (hemorrhage, thrombosis, vasculopathy).
  • 12 patients required blood patches for spinal headaches; 2 had minor residual neurologic damage.

Conclusions:

  • Persistent postpartum headaches demand a stepwise, multidisciplinary approach.
  • Consider preeclampsia in hypertensive, proteinuric women; tension-type/migraine or spinal headache in normotensive women.
  • Headaches refractory to treatment or with neurologic deficits require cerebral imaging to rule out life-threatening causes.