A Hospital Based Retrospective Study of Acute Postpartum Headache

Angeliki Vgontzas, Matthew S. Robbins

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To describe acute headache diagnoses in women presenting emergently in the postpartum period and to determine which factors may be associated with secondary vs primary headache. Background: Hormonal, vascular, and procedural factors elevate the risk for both secondary and primary headache disorders in the postpartum period. Differentiating between these can be a diagnostic challenge, particularly among the most severe patients referred for urgent neurological consultation. Methods: A single-center retrospective study of consecutive postpartum women age ≥18 years presenting with acute headache to a large urban tertiary-care hospital and receiving neurological consultation. Results: Of 63 women who presented with acute postpartum headache, 17 (27.0%) were diagnosed with a primary headache disorder and 46 (73.0%) were diagnosed with a secondary headache disorder. Migraine comprised the majority of primary headache diagnoses (76.5%). Secondary headache most commonly featured postdural puncture headache (PDPH) (45.7%), postpartum preeclampsia (PEC) (26.1%), and a diverse group of cerebrovascular headache disorders (21.7%). Presentation within 24 hours and lack of side predominance helped to differentiate PDPH from migraine. However, abnormal diagnostic testing was more prevalent in the patients with headache secondary to cerebrovascular disorders/PEC. Conclusions: Nearly three-quarters of postpartum women who present with acute onset headache and receiving neurological consultation are found to have a secondary headache - with nearly half of the secondary headaches attributed to PEC or cerebrovascular headache disorders. The absence of a headache history and a clear PDPH description should prompt strong consideration for neuroimaging to rule out cerebrovascular etiologies of headache as well as close monitoring for signs and symptoms of preeclampsia in women presenting with acute severe postpartum headache.

Original languageEnglish (US)
JournalHeadache
DOIs
StateAccepted/In press - Jan 1 2018

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Postpartum Period
Headache
Retrospective Studies
Post-Dural Puncture Headache
Pre-Eclampsia
Cerebrovascular Disorders
Secondary Headache Disorders
Primary Headache Disorders
Headache Disorders
Referral and Consultation
Migraine Disorders
Urban Hospitals
Tertiary Healthcare
Tertiary Care Centers
Neuroimaging
Signs and Symptoms

Keywords

  • Postpartum
  • Preeclampsia
  • Secondary headache disorders

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

A Hospital Based Retrospective Study of Acute Postpartum Headache. / Vgontzas, Angeliki; Robbins, Matthew S.

In: Headache, 01.01.2018.

Research output: Contribution to journalArticle

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AB - Objective: To describe acute headache diagnoses in women presenting emergently in the postpartum period and to determine which factors may be associated with secondary vs primary headache. Background: Hormonal, vascular, and procedural factors elevate the risk for both secondary and primary headache disorders in the postpartum period. Differentiating between these can be a diagnostic challenge, particularly among the most severe patients referred for urgent neurological consultation. Methods: A single-center retrospective study of consecutive postpartum women age ≥18 years presenting with acute headache to a large urban tertiary-care hospital and receiving neurological consultation. Results: Of 63 women who presented with acute postpartum headache, 17 (27.0%) were diagnosed with a primary headache disorder and 46 (73.0%) were diagnosed with a secondary headache disorder. Migraine comprised the majority of primary headache diagnoses (76.5%). Secondary headache most commonly featured postdural puncture headache (PDPH) (45.7%), postpartum preeclampsia (PEC) (26.1%), and a diverse group of cerebrovascular headache disorders (21.7%). Presentation within 24 hours and lack of side predominance helped to differentiate PDPH from migraine. However, abnormal diagnostic testing was more prevalent in the patients with headache secondary to cerebrovascular disorders/PEC. Conclusions: Nearly three-quarters of postpartum women who present with acute onset headache and receiving neurological consultation are found to have a secondary headache - with nearly half of the secondary headaches attributed to PEC or cerebrovascular headache disorders. The absence of a headache history and a clear PDPH description should prompt strong consideration for neuroimaging to rule out cerebrovascular etiologies of headache as well as close monitoring for signs and symptoms of preeclampsia in women presenting with acute severe postpartum headache.

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