Beyond postdural puncture headache: headache and the puerperium

This review describes the evaluation, diagnosis, and management of less-common etiologies of postpartum headache, and offers a systematic approach to the evaluation, diagnosis, and treatment of the parturient with this very common complaint.

Approximately 40% of parturients develop a headache in the immediate postpartum period, with roughly half of these attributable to an underlying etiology or disorder. Unfortunately, the confounding nature of the postpartum state, with attendant fatigue, stress, sleep deprivation, and other derangements of normal physiology, and the heterogeneity of postpartum disorders leading to headache, often delay diagnosis of these rare forms of headache.

Although postdural puncture headache and headache as a symptom of preeclampsia comprise the majority of "secondary" postpartum headaches, other less-common causes of postpartum headache include headaches caused by cerebral vascular abnormalities, hemorrhagic processes, or mass effects/space-occupying lesions. Many of these less-common headaches herald serious underlying disorders that present a significant threat to patient health and require prompt diagnosis and treatment.