Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Postpartum Headache Other Than Post–Dural Puncture Headache


Case Synopsis

A 24-year-old primigravida underwent cesarean section for breech presentation under uncomplicated spinal anesthesia performed with a 27-gauge Whitacre needle. On the second postpartum day, she complained of a severe, diffuse headache. On the third postpartum day, she suffered a grand mal seizure. The obstetrician believes the headache is a spinal headache, and the anesthesiologist is consulted.

Problem Analysis

Definition

Postpartum headache has been defined as any headache occurring during the first 6 weeks after delivery. Such headaches can be caused by a preexisting condition, may be a manifestation of an intrapartum event, or can be due to an unrelated disorder arising coincidentally in the postpartum period. There is a natural inclination, particularly on the part of patients and obstetricians, to blame any postpartum headache on a neuraxial anesthetic, but not all postpartum headaches are post–dural puncture headaches, even when a large-gauge dural puncture is known to have occurred. This chapter discusses the most common causes of headache in the postpartum period, as well as some less common conditions whose misdiagnosis can lead to a potentially catastrophic outcome.

Recognition

Although the incidence of a particular type of headache may be different in women who have recently delivered, any headache that is seen in the general population can occur in the postpartum period. In 2013 the International Headache Society published a beta version of the third edition of its diagnostic and classification criteria. A complete discussion of these criteria is beyond the scope of this review, but the division of headaches into primary and secondary provides a useful framework for discussion ( Box 174.1 ).

BOX 174.1
Classification of Postpartum Headache
Data from Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9):629-808, 2013.

Primary Headache

  • Migraine (with or without aura)

  • Tension-type headache

Secondary Headache

  • Headache attributed to cranial vascular disorders

    • Intracranial hemorrhage

    • Cerebral venous and sinus thrombosis

  • Headache attributed to nonvascular intracranial disorders

    • Tumor

    • Idiopathic intracranial hypertension

    • Pneumocephalus

  • Headache attributed to a substance or its withdrawal

  • Headache attributed to disorder of homeostasis

    • Preeclampsia

    • Metabolic disorders

  • Headache from infectious causes

    • Meningitis

    • Sinusitis

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here