Postpartum headache - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:57:57Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:57, 22 March 2026
Line 10:		Line 10:

	*Secondary		*Secondary
	**[[Postdural puncture headache]]		**[[Postdural puncture headache]]<ref>Amorim JA, et al. Postdural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012;32(12):916-923. PMID 22843225</ref>
	**[[Preeclampsia]]/[[Eclampsia]]		**[[Preeclampsia]]/[[Eclampsia]]
	**[[Cerebral venous sinus thrombosis]]		**[[Cerebral venous sinus thrombosis]]

SeanDenny at 02:29, 14 December 2020

2020-12-14T02:29:29Z

← Older revision		Revision as of 02:29, 14 December 2020
Line 106:		Line 106:
	**↑ protein/cell counts in 35-50%		**↑ protein/cell counts in 35-50%
	*[[Head CT\|CT]]: Often negative		*[[Head CT\|CT]]: Often negative
	*[[~~brian~~ MRI\|MRV]] (preferred): Intraluminal clot flow voids		*[[brain MRI\|MRV]] (preferred): Intraluminal clot flow voids

	==See Also==		==See Also==

ClaireLewis: /* Preeclampsia */

2019-10-16T17:25:58Z

Preeclampsia

← Older revision		Revision as of 17:25, 16 October 2019
Line 40:		Line 40:
	**Edema		**Edema
	**↑ DTRs		**↑ DTRs
	**Proteinuria		**[[Proteinuria]]

	*[[LP\|CSF]]: Normal		*[[LP\|CSF]]: Normal

ClaireLewis at 00:17, 2 October 2019

2019-10-02T00:17:46Z

← Older revision		Revision as of 00:17, 2 October 2019
Line 6:		Line 6:
	==Differential Diagnosis==		==Differential Diagnosis==
	*Primary		*Primary
	**Tension-type headache (most common cause)		**Tension-type [[tension headache\|headache]] (most common cause)
	**Migraine headache (2nd most common cause)		**[[Migraine]] headache (2nd most common cause)

	*Secondary		*Secondary
Line 14:		Line 14:
	**[[Cerebral venous sinus thrombosis]]		**[[Cerebral venous sinus thrombosis]]
	**[[Stroke]] (ischemic or hemorrhagic)		**[[Stroke]] (ischemic or hemorrhagic)
	**Ruptured aneurysm or malformation		**Ruptured aneurysm or [[AVM\|malformation]]
	**[[Posterior Reversible Encephalopathy Syndrome (PRES)]]		**[[Posterior Reversible Encephalopathy Syndrome (PRES)]]
	**Postpartum cerebral angiopathy		**Postpartum cerebral angiopathy
Line 35:		Line 35:
	*Findings:		*Findings:
	**Bilateral, throbbing headache		**Bilateral, throbbing headache
	**Blurred vision/scintillating scotomata		**[[Blurred vision]]/scintillating scotomata
	**~~hypertension~~		**[[Hypertension]]
	**Epigastric/RUQ pain		**[[epigastric pain\|Epigastric]]/[[RUQ pain]]
	**Edema		**Edema
	**↑ DTRs		**↑ DTRs
	**Proteinuria		**Proteinuria

	*CSF: Normal		*[[LP\|CSF]]: Normal

	===[[SAH]]===		===[[SAH]]===
	*↑ risk due to combination of vasodilatation from hyperestrogenic state and vasalvic pressure from labor		*↑ risk due to combination of vasodilatation from hyperestrogenic state and vasalvic pressure from labor
	*Require CT → LP if CT negative for SAH		*Require [[head CT\|CT]] → [[LP]] if CT negative for SAH
	**If above negative, consider CVT vs. RCVS vs. cervicocranial arterial dissection		**If above negative, consider CVT vs. RCVS vs. cervicocranial arterial dissection
	**Further work-up includes MRI vascular studies, MRI with diffusion-weighted imaging		**Further work-up includes [[brain MRI\|MRI]] vascular studies, MRI with diffusion-weighted imaging

	===[[Postdural Puncture Headaches]]===		===[[Postdural Puncture Headaches]]===
Line 58:		Line 58:
	**Nuchal/occipital		**Nuchal/occipital
	**Worsen upon standing/resolve with 10-15 mins of recumbency		**Worsen upon standing/resolve with 10-15 mins of recumbency
	**+/- tinnitus, diplopia, ~~hypacusia~~		**+/- [[tinnitus]], [[diplopia]], hypoacusia

	~~===Posterior Reversible Encephalopathy Syndrome (PRES)===~~

			===[[Posterior reversible encephalopathy syndrome]] (PRES)===
	*Onset over hours		*Onset over hours
	*Findings		*Findings
	**Early seizures		**Early [[seizures]]
	**Stupor		**[[AMS\|Stupor]]
	**Visual loss/hallucinations		**[[vision loss\|Visual loss]]/[[hallucinations]]
	**Dull/throbbing headache (not thunderclap)		**Dull/throbbing headache (not thunderclap)

	*Symptoms resolve within days-weeks if BP controlled		*Symptoms resolve within days-weeks if BP controlled
	*CSF: normal, +/- ↑ protein		*[[LP\|CSF]]: normal, +/- ↑ protein
	*Imaging		*Imaging
	**CT: findings in ~50% of patients		**[[head CT\|CT]]: findings in ~50% of patients
	**MRI: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes		**[[Brain MRI\|MRI]]: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes
	**Intracerebral hemorrhage in 15% of patients		**[[Intracerebral hemorrhage]] in 15% of patients

	===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===		===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===

	*Abrupt onset		*Abrupt onset
	*Findings		*Findings
	**"Thunderclap" headache		**"Thunderclap" headache
	**Multiple episodes		**Multiple episodes
	**+/- seizures		**+/- [[seizures]]
	**Transient focal deficits		**Transient [[focal neuro deficits\|focal deficits]]
	*Typical Course		*Typical Course
	**First week: headaches		**First week: headaches
	**Second week: intracerebral hemorrhage		**Second week: [[intracerebral hemorrhage]]
	**Third week: Ischemic complications		**Third week: Ischemic complications
	*CSF: 50% of patients with mild pleocytosis and protein ↑		*[[LP\|CSF]]: 50% of patients with mild pleocytosis and protein ↑
	*CT: normal		*[[CT head\|CT]]: normal
	*CT angio/MRI		*CT angio/MRI
	**String-of-beads constriction pattern of cerebral arteries		**String-of-beads constriction pattern of cerebral arteries
Line 97:		Line 94:

	===[[Cerebral venous sinus thrombosis]]===		===[[Cerebral venous sinus thrombosis]]===
			*75% of cases are postpartum
	*75% cases postpartum
	*Findings		*Findings
	**Progressive, diffuse; rarely thunderclap		**Progressive, diffuse; rarely thunderclap
	**Dizziness		**[[Dizziness]]
	**Nausea		**[[Nausea]]
	**~~Papilloedema~~		**[[Papilledema]]
	**Lethargy		**[[Lethargy]]
	**Seizures in 40%		**[[Seizures]] in 40%
			*[[LP\|CSF]]
	*CSF
	**↑ opening pressure in 80%		**↑ opening pressure in 80%
	**↑ protein/cell counts in 35-50%		**↑ protein/cell counts in 35-50%
	*CT: Often negative		*[[Head CT\|CT]]: Often negative
	*MRV (preferred): Intraluminal clot flow voids		*[[brian MRI\|MRV]] (preferred): Intraluminal clot flow voids

	==See Also==		==See Also==
Line 125:		Line 120:
	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:OBGYN]]		[[Category:OBGYN]]
			[[Category:Symptoms]]

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-31T04:46:06Z

Text replacement - "HTN" to "hypertension"

← Older revision		Revision as of 04:46, 31 July 2016
Line 36:		Line 36:
	**Bilateral, throbbing headache		**Bilateral, throbbing headache
	**Blurred vision/scintillating scotomata		**Blurred vision/scintillating scotomata
	**~~HTN~~		**hypertension
	**Epigastric/RUQ pain		**Epigastric/RUQ pain
	**Edema		**Edema

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T16:49:43Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 16:49, 24 July 2016
Line 25:		Line 25:
	{{Postpartum emergencies DDX}}		{{Postpartum emergencies DDX}}

	==~~Diagnosis~~==		==Evaluation==

	===Primary Headaches===		===Primary Headaches===

Neil.m.young: Text replacement - "# " to "#"

2016-07-06T23:50:33Z

Text replacement - "# " to "#"

← Older revision		Revision as of 23:50, 6 July 2016
Line 118:		Line 118:

	==References==		==References==
	# Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. The Lancet Neurology 2013;12:175-85.		#Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. The Lancet Neurology 2013;12:175-85.
	# Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2005;52:971-7.		#Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2005;52:971-7.
	# Klein AM, Loder E. Postpartum headache. International journal of obstetric anesthesia 2010;19:422-30.		#Klein AM, Loder E. Postpartum headache. International journal of obstetric anesthesia 2010;19:422-30.
	# Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? American journal of obstetrics and gynecology 2007;196:318 e1-7.		#Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? American journal of obstetrics and gynecology 2007;196:318 e1-7.

	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:OBGYN]]		[[Category:OBGYN]]

Neil.m.young: Text replacement - "* " to "*"

2016-07-04T14:08:53Z

Text replacement - "* " to "*"

← Older revision		Revision as of 14:08, 4 July 2016
Line 2:		Line 2:
	==Background==		==Background==

	* 40% of postpartum women have headaches; a majority are in the first week of delivery.		*40% of postpartum women have headaches; a majority are in the first week of delivery.

	==Differential Diagnosis==		==Differential Diagnosis==
	* Primary		*Primary
	** Tension-type headache (most common cause)		**Tension-type headache (most common cause)
	** Migraine headache (2nd most common cause)		**Migraine headache (2nd most common cause)

	* Secondary		*Secondary
	**[[Postdural puncture headache]]		**[[Postdural puncture headache]]
	**[[Preeclampsia]]/[[Eclampsia]]		**[[Preeclampsia]]/[[Eclampsia]]
Line 20:		Line 20:
	**[[SAH]]		**[[SAH]]
	**[[Amniotic Fluid Embolus]]		**[[Amniotic Fluid Embolus]]
	** Choriocarcinoma		**Choriocarcinoma
	** [[Air embolism]]		**[[Air embolism]]

	{{Postpartum emergencies DDX}}		{{Postpartum emergencies DDX}}
Line 28:		Line 28:

	===Primary Headaches===		===Primary Headaches===
	* Tension-type headache most common		*Tension-type headache most common
	* Incidence of migraines increases postpartum due to estrogen withdrawal		*Incidence of migraines increases postpartum due to estrogen withdrawal
	** Avoid ergotamines in breast-feeding patients		**Avoid ergotamines in breast-feeding patients

	===[[Preeclampsia]]===		===[[Preeclampsia]]===
	* Findings:		*Findings:
	** Bilateral, throbbing headache		**Bilateral, throbbing headache
	** Blurred vision/scintillating scotomata		**Blurred vision/scintillating scotomata
	** HTN		**HTN
	** Epigastric/RUQ pain		**Epigastric/RUQ pain
	** Edema		**Edema
	** ↑ DTRs		**↑ DTRs
	** Proteinuria		**Proteinuria

	* CSF: Normal		*CSF: Normal

	===[[SAH]]===		===[[SAH]]===
	* ↑ risk due to combination of vasodilatation from hyperestrogenic state and vasalvic pressure from labor		*↑ risk due to combination of vasodilatation from hyperestrogenic state and vasalvic pressure from labor
	* Require CT → LP if CT negative for SAH		*Require CT → LP if CT negative for SAH
	** If above negative, consider CVT vs. RCVS vs. cervicocranial arterial dissection		**If above negative, consider CVT vs. RCVS vs. cervicocranial arterial dissection
	** Further work-up includes MRI vascular studies, MRI with diffusion-weighted imaging		**Further work-up includes MRI vascular studies, MRI with diffusion-weighted imaging

	===[[Postdural Puncture Headaches]]===		===[[Postdural Puncture Headaches]]===
	* Due to ↓ intracranial pressure secondary to CSF leak		*Due to ↓ intracranial pressure secondary to CSF leak
	* Incidence: 0.5-1.5% of women receiving epidural anesthesia		*Incidence: 0.5-1.5% of women receiving epidural anesthesia
	** Can occur in women who have not received epidural secondary to dural tears during labor		**Can occur in women who have not received epidural secondary to dural tears during labor
	* Findings		*Findings
	** Begin 1-7 day postpartum		**Begin 1-7 day postpartum
	** Nuchal/occipital		**Nuchal/occipital
	** Worsen upon standing/resolve with 10-15 mins of recumbency		**Worsen upon standing/resolve with 10-15 mins of recumbency
	** +/- tinnitus, diplopia, hypacusia		**+/- tinnitus, diplopia, hypacusia

	===Posterior Reversible Encephalopathy Syndrome (PRES)===		===Posterior Reversible Encephalopathy Syndrome (PRES)===

	* Onset over hours		*Onset over hours
	* Findings		*Findings
	** Early seizures		**Early seizures
	** Stupor		**Stupor
	** Visual loss/hallucinations		**Visual loss/hallucinations
	** Dull/throbbing headache (not thunderclap)		**Dull/throbbing headache (not thunderclap)

	* Symptoms resolve within days-weeks if BP controlled		*Symptoms resolve within days-weeks if BP controlled
	* CSF: normal, +/- ↑ protein		*CSF: normal, +/- ↑ protein
	* Imaging		*Imaging
	** CT: findings in ~50% of patients		**CT: findings in ~50% of patients
	** MRI: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes		**MRI: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes
	** Intracerebral hemorrhage in 15% of patients		**Intracerebral hemorrhage in 15% of patients

	===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===		===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===

	* Abrupt onset		*Abrupt onset
	* Findings		*Findings
	** "Thunderclap" headache		**"Thunderclap" headache
	** Multiple episodes		**Multiple episodes
	** +/- seizures		**+/- seizures
	** Transient focal deficits		**Transient focal deficits
	* Typical Course		*Typical Course
	** First week: headaches		**First week: headaches
	** Second week: intracerebral hemorrhage		**Second week: intracerebral hemorrhage
	** Third week: Ischemic complications		**Third week: Ischemic complications
	* CSF: 50% of patients with mild pleocytosis and protein ↑		*CSF: 50% of patients with mild pleocytosis and protein ↑
	* CT: normal		*CT: normal
	* CT angio/MRI		*CT angio/MRI
	** String-of-beads constriction pattern of cerebral arteries		**String-of-beads constriction pattern of cerebral arteries
	** Digital subtraction angiogram more sensitive		**Digital subtraction angiogram more sensitive
	** +/- cervical arterial dissection		**+/- cervical arterial dissection
	** Initial arteriogram may be negative		**Initial arteriogram may be negative

	===[[Cerebral venous sinus thrombosis]]===		===[[Cerebral venous sinus thrombosis]]===

	* 75% cases postpartum		*75% cases postpartum
	* Findings		*Findings
	** Progressive, diffuse; rarely thunderclap		**Progressive, diffuse; rarely thunderclap
	** Dizziness		**Dizziness
	** Nausea		**Nausea
	** Papilloedema		**Papilloedema
	** Lethargy		**Lethargy
	** Seizures in 40%		**Seizures in 40%

	* CSF		*CSF
	** ↑ opening pressure in 80%		**↑ opening pressure in 80%
	** ↑ protein/cell counts in 35-50%		**↑ protein/cell counts in 35-50%
	* CT: Often negative		*CT: Often negative
	* MRV (preferred): Intraluminal clot flow voids		*MRV (preferred): Intraluminal clot flow voids

	==See Also==		==See Also==

Neil.m.young: Text replacement - "2/2" to "secondary to"

2016-07-04T07:43:52Z

Text replacement - "2/2" to "secondary to"

← Older revision		Revision as of 07:43, 4 July 2016
Line 51:		Line 51:

	===[[Postdural Puncture Headaches]]===		===[[Postdural Puncture Headaches]]===
	* Due to ↓ intracranial pressure ~~2/2~~ CSF leak		* Due to ↓ intracranial pressure secondary to CSF leak
	* Incidence: 0.5-1.5% of women receiving epidural anesthesia		* Incidence: 0.5-1.5% of women receiving epidural anesthesia
	** Can occur in women who have not received epidural ~~2/2~~ dural tears during labor		** Can occur in women who have not received epidural secondary to dural tears during labor
	* Findings		* Findings
	** Begin 1-7 day postpartum		** Begin 1-7 day postpartum

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:50:33Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:50, 21 June 2016
Line 72:		Line 72:
	* CSF: normal, +/- ↑ protein		* CSF: normal, +/- ↑ protein
	* Imaging		* Imaging
	** CT: findings in ~50% of ~~pts~~		** CT: findings in ~50% of patients
	** MRI: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes		** MRI: Prominent T2-weighted and FLAIR, often in parieto-occipital lobes
	** Intracerebral hemorrhage in 15% of ~~pts~~		** Intracerebral hemorrhage in 15% of patients

	===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===		===Reversible Cerebral Vasoconstriction Syndrome (RCVS)===
Line 88:		Line 88:
	** Second week: intracerebral hemorrhage		** Second week: intracerebral hemorrhage
	** Third week: Ischemic complications		** Third week: Ischemic complications
	* CSF: 50% of ~~pts~~ with mild pleocytosis and protein ↑		* CSF: 50% of patients with mild pleocytosis and protein ↑
	* CT: normal		* CT: normal
	* CT angio/MRI		* CT angio/MRI