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Diagnosing and managing peripartum headache

Erica N Grant1, Jia Wang1, Brian Gelpi1

  • 1Department of Anesthesiology and Pain Management (Grant, Wang, Gelpi, Tao) and the Department of Obstetrics and Gynecology (Wortman), University of Texas Southwestern Medical Center, Dallas, Texas.

Proceedings (Baylor University. Medical Center)
|October 2, 2015
PubMed

A 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation presented with a postpartum headache following vaginal delivery complicated by an unintentional dural puncture for epidural analgesia. Due to the positional nature of the headache and its frontal and occipital origin, a postdural puncture headache was diagnosed. After failure of conservative treatment, an epidural blood patch was used, which offered immediate relief. However, shortly following the procedure, the parturient's neurological condition deteriorated due to an unrecognized intraparenchymal and subarachnoid hemorrhage requiring an emergent craniectomy. This case highlights the importance of diligence when evaluating and treating postpartum headache despite a classic presentation.

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