Research
Obstetrics
Postpartum headache: is your work-up complete?

Presented at the 27th Annual Clinical Meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 5-10, 2007.
https://doi.org/10.1016/j.ajog.2007.01.034Get rights and content

Objective

Headache is a common finding in the postpartum period, and there are limited data describing the cause and treatment of women with postpartum headache. Our objective was to describe our experience with women who were hospitalized for postpartum headache and to develop a management algorithm for these women.

Study Design

Data for 95 women with headache >24 hours after delivery from 2000-2005 were reviewed retrospectively. Maternal assessment included an evaluation for benign and serious causes of headache that included preeclampsia, dural puncture, and neurologic lesions. Neurologic imaging were performed on the basis of initial neurologic findings and clinical course. Outcomes that were studied included cause, a need for cerebral imaging, neurologic findings, maternal complications, and long-term follow-up evaluations.

Results

The mean onset of headache was 3.4 days (range, 2-32 days) after delivery. Tension-type/migraine headache was the most common cause (47%). Preeclampsia/eclampsia and spinal headache comprised 24% and 16% of cases, respectively. Anesthesia evaluation was required in 15 patients because of suspected spinal headache; blood patch was required in 12 of these patients. Cerebral imaging was performed in 22 patients because of focal neurologic deficits and/or failure to respond to initial therapy; 15 of these women (68%) had abnormal findings. Ten patients had serious cerebral pathologic findings, such as hemorrhage, thrombosis, or vasculopathy. There were no deaths; 2 women had minor residual neurologic damage on follow-up evaluation.

Conclusion

The evaluation of persistent headaches that develop >24 hours after delivery must be performed in a stepwise fashion and requires a multidisciplinary approach. Preeclampsia should be considered initially in women with hypertension and proteinuria. Normotensive women should be evaluated initially for tension-type/migraine headache or spinal headache. Patients with headache that is refractory to usual therapy and patients with neurologic deficit require cerebral imaging to detect the presence of life-threatening causes.

Section snippets

Material and Methods

This was a retrospective analysis of data for patients who were hospitalized because of postpartum headache at The University Hospital, Inc, between the years 2000 and 2005. Postpartum headache was defined as the onset of severe unrelenting headache >24 hours from the time of delivery and within 42 days after delivery. Based on this definition, the inclusion criteria were patients who had a headache >24 hours who were either in the hospital or who were readmitted because of a headache and

Results

During the study period, 95 patients with severe headache >24 hours after delivery were identified. Seventy-eight of these women (82%) were already in the hospital at the onset of their headache, and 17 of the women (18%) were reevaluated for headache after discharge. Fourteen of the latter 17 patients required readmission because of their symptoms; 3 women were discharged home from the triage area after evaluation and treatment.

Table 1 describes the demographic characteristics of the study

Comment

The findings of our study provide important information regarding the initial evaluation and subsequent treatment of women who experience persistent headaches > 24 hours after delivery, particularly those with headaches after discharge from the hospital. Many of these patients are seen initially by either an obstetrician or an emergency room physician. In addition, anesthesiologists and/or neurologists may also be called to provide help in the treatment of these cases.

Our findings show that the

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    Cite this article as: Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? Am J Obstet Gynecol 2007;196:318.e1-318.e7.

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