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Headache is a common finding in the postpartum (PP) period. However, there is limited data describing the etiology and management of women with PP headache presenting >24 hours after delivery. Our objective is to describe our experience with a large number of women with PP headache.
Ninety-five women with headache beyond 24 hours postpartum managed from 2000-2005. Maternal assessment included evaluation for preeclampsia (PE), dural puncture, neurologic evaluation and neurodiagnostic imaging when indicated. Outcomes studied included etiology, neurologic findings, maternal complications and long-term follow-up.
The mean onset of headache was 3.4 days (range, 1-32) postpartum. Etiologies are summarized in Table 1. Radiologic imaging (CT Scan, MRI, MRA, MRV) was performed in 25%. Medications administered were magnesium sulfate (24%), antihypertensive agents (8%), anticonvulsants (5%), anticoagulants (3%) and bromocriptine (1%). Neurological consult was obtained in 23%: 4% of these patients had outpatient follow up and 2% sustained residual neurologic symptoms. Anesthesia evaluation was performed on 16%: of these, blood patch was administered to 13%.
The evaluation of late postpartum headache requires a multidisciplinary approach and must be performed in a stepwise fashion. Preeclampsia should be considered particularly in women with hypertension and/or proteinuria. Normotensive nonproteinuric women should be evaluated for spinal headache (SH). Refractory headache in patients without a history of migraine (MH) or tension headache (TH) and those with neurologic deficit should have neurodiagnostic imaging to detect the presence of life threatening etiologies.