ResearchObstetricsPostpartum headache: is your work-up complete?
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
References (44)
- et al.
Puerperal seizures after post-dural puncture headache
Obstet Gynecol
(1995) Diagnosis and management of chronic hypertension and preeclampsia
Obstet Gynecol
(2003)- et al.
Post-dural puncture headache: pathogenesis, prevention and treatment
Br J Anesth
(2003) - et al.
Migrainous hemiplegia during breastfeeding
Am J Obstet Gynecol
(1974) - et al.
Late postpartum eclampsia: a preventable disease?
Am J Obstet Gynecol
(2002) - et al.
Late postpartum eclampsia as an obstetric complication in the ED
Am J Emerg Med
(2005) - et al.
Postpartum cerebral angiopathy: an important diagnostic consideration in the postpartum period
Am J Obstet Gynecol
(2004) - et al.
Intracerebral hemorrhage and postpartum cerebral vasculopathy
J Neurol Sci
(2002) Headaches in the first post partum week and their relationship to migraine
Behav Assess
(1988)- et al.
Headaches after childbirth
Acta Neurol Scand
(1984)
The incidence and etiology of postpartum headaches
Obstet Pediatr Anesth
Headache during pregnancy in the postpartum: a prospective study
Headache
Headache in the first postpartum week and their relationship to migraine
Headache
Course of migraine during pregnancy and postpartum: a prospective study
Cephalalgia
Longitudinal prospective study if headache during pregnancy and postpartum
Headache
Persistent postpartum headache from a chronic subdural hematoma after epidural anesthesia
Obstet Gynecol
Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus
Obstet Gynecol
Postpartum eclampsia complicated by reversible cerebral herniation
Obstet Gynecol
Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome
Obstet Gynecol
The international classification of headache disorders
Cephalalgia
Acute puerperal coital headache and hypertension
Aust N Z J Obstet Gynaecol
Diagnosis, prevention and management of eclampsia
Obstet Gynecol
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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.