Postpartum Headache

Don't Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review

Headache is a common finding in the postpartum period, caused by a spectrum of different conditions. Most headaches in the postpartum period are self-limiting and benign in etiology, but there are some potentially serious causes to be considered. We disclose two cases of postpartum headache, initially considered as post-dural puncture headache (PDPH), that evolved into a harmful condition and showed that an expanded differential diagnosis for headache in the postpartum is mandatory, requiring a high level of attention from health professionals. In fact, a careful examination of the medical history, physical examination, and the recognition for the need for early neuroradiological imaging should increase diagnostic accuracy.

Brain magnetic resonance imaging findings in postpartum headache

OBJECTIVES

The objectives were to determine the frequency of abnormal magnetic resonance imaging findings in patients with postpartum headache and related factors.

METHODS

A total of 102 patients with postpartum headache underwent brain magnetic resonance imaging study. The images were examined by a blinded radiologist. The related demographic, obstetric and headache-related factors were recorded. The multiple logistic regression model was used to determine the predictive factors.

RESULTS

Abnormal magnetic resonance imaging findings were observed in 42 of 102 patients (41.2%, 95% confidence interval = 31.6 to 50.7%). The most common finding was sinusitis (10 of 42 patients, 23.8%, 95% confidence interval = 15.5 to 32%). Then, posterior reversible encephalopathy syndrome (six of 42 cases, 14.2%, 95% confidence interval = 7.4 to 20.9%), cerebral venous thrombosis (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%), and subarachnoid hemorrhage (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%) were most prevalent findings. Convulsions (odds ratio of 3.39) and initiation of headache earlier than 5 days postpartum (odds ratio of 0.29) were significant predictive factors.

CONCLUSION

Abnormal brain magnetic resonance imaging findings were seen in a considerable number of patients with postpartum headache. When headache starts in the first 5 days postpartum and accompanied by convulsions, there are likely to be abnormal magnetic resonance imaging findings.