Acute Headache in Pregnant Women

Author: Robbins MS et al., Neurology 2015 Sep 22; 85:1024

New findings from a hospital-based retrospective study suggest some differences in primary versus secondary headache characteristics in this population.

In this retrospective chart review, researchers describe demographics, comorbidities, and clinical features of acute headache in pregnant women who received a neurological consultation for headache at one hospital between 2009 and 2014. Additionally, the authors sought to identify salient characteristics that may distinguish primary and secondary headaches in this population.

Of the 140 women studied, most (56.4%) were in the third trimester of pregnancy. Those presenting with primary versus secondary headaches did not differ in age, race, or number of pregnancies. Ultimately, 65% were diagnosed with a primary headache, most frequently migraine (59.3% of the overall sample and 91.2% of those with primary headache). Unsurprisingly, depression, anxiety, and bipolar disorder were more frequent in those with a primary headache. Hypertensive disorders of pregnancy were the most commonly identified cause of secondary headache (51.0% of secondary headaches), particularly preeclampsia (38.8% of secondary headaches). Those with a secondary headache were more likely to lack a previous headache history, have an abnormal exam, and present with fever, seizure, or high blood pressure. Presence of hypertension and lack of a headache history were the two greatest risk factors for a secondary headache diagnosis. Most women (87.9%) underwent neuroimaging, usually brain magnetic resonance imaging (78.6%); 17.8% of these had abnormal imaging findings that led to a secondary headache diagnosis.

Comment This is the first large study to elucidate the demographics and characteristics of acute headache in pregnant women. As evidenced, differentiating between an exacerbation of a primary headache and the onset of a serious secondary headache, based on headache description alone, can be challenging. Given the lack of diagnostic parameters and the increased risks of secondary headache during pregnancy, most pregnant women with new headache receive a thorough workup, including neuroimaging. Additional studies aimed at improving our understanding of headache during pregnancy would be helpful. Meanwhile, practitioners should remain vigilant for a potential secondary headache diagnosis in pregnant women, particularly those who present with acute headache, hypertension, and lack a previous headache history.