II. Types: Primary Headaches
- Tension Headache
-
Migraine Headache
- Improves with pregnancy in up to 70% of patients
- Some cases of first Migraine occur in first trimester
- Associated with aura
- Chronic Daily Headache
III. Differential Diagnosis: Secondary Headaches in Antepartum Period
- See Headache for other causes
- See Headache Red Flags
-
Pregnancy Induced Hypertension (Preeclampsia)
- Consider after 20 weeks
IV. Differential Diagnosis: Secondary Headaches in Postpartum Period (Postpartum Headache)
- See Headache for other causes
- See Headache Red Flags
-
Pregnancy Induced Hypertension (Preeclampsia)
- May occur up to 6 weeks after delivery
- Critical diagnosis commonly missed in postpartum patients (Magnesium IV is drug of choice)
- Evaluate for Hypertension and Proteinuria (or alternative criteria) in all Postpartum Headache patients
- Posterior Reversible Encephalopathy Syndrome (PRES)
- Reversible Cerebral Vasoconstriction Syndrome
- Post-epidural Headache
- Cerebral Venous Thrombosis (Cortical Vein Thrombosis)
- Spontaneous Subarachnoid Hemorrhage
- Meningitis
- Pituitary Apoplexy
V. Management
VI. References
- Jhun, Weinstock and Jaque in Herbert (2017) EM:Rap 17(1): 14-5
- Johnson (2004) Prim Care Office Pract 31:417-28
- Gregory (2018) Am Fam Physician 98(9): 595-602 [PubMed]
- Silberstein (2004) Neurol Clin 22:727-56 [PubMed]