II. Types: Primary Headaches

  1. Tension Headache
  2. Migraine Headache
    1. Improves with pregnancy in up to 70% of patients
    2. Some cases of first Migraine occur in first trimester
      1. Associated with aura
  3. Chronic Daily Headache

III. Differential Diagnosis: Secondary Headaches in Antepartum Period

  1. See Headache for other causes
  2. See Headache Red Flags
  3. Pregnancy Induced Hypertension (Preeclampsia)
    1. Consider after 20 weeks

IV. Differential Diagnosis: Secondary Headaches in Postpartum Period (Postpartum Headache)

  1. See Headache for other causes
  2. See Headache Red Flags
  3. Pregnancy Induced Hypertension (Preeclampsia)
    1. May occur up to 6 weeks after delivery
    2. Critical diagnosis commonly missed in postpartum patients (Magnesium IV is drug of choice)
    3. Evaluate for Hypertension and Proteinuria (or alternative criteria) in all Postpartum Headache patients
  4. Posterior Reversible Encephalopathy Syndrome (PRES)
  5. Reversible Cerebral Vasoconstriction Syndrome
    1. Thunderclap Headache
  6. Post-epidural Headache
    1. Spinal Headache (Post-Lumbar puncture headache)
    2. Pneumocephalus
  7. Cerebral Venous Thrombosis (Cortical Vein Thrombosis)
  8. Spontaneous Subarachnoid Hemorrhage
  9. Meningitis
  10. Pituitary Apoplexy

VI. References

  1. Jhun, Weinstock and Jaque in Herbert (2017) EM:Rap 17(1): 14-5
  2. Johnson (2004) Prim Care Office Pract 31:417-28
  3. Gregory (2018) Am Fam Physician 98(9): 595-602 [PubMed]
  4. Silberstein (2004) Neurol Clin 22:727-56 [PubMed]

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