A secondary headache etiology was found via brain imaging in more than 25% of pregnant women with acute headache, including cerebral venous thrombosis (CVT), posterior reversible encephalopathy syndrome (PRES), intracranial hemorrhage, sinusitis, and stroke, according to a study published in the Journal of Neurology. Seizures, changes in consciousness, and strong pain intensity were the strongest predictors for pathological findings.
For this study, investigators conducted a retrospective chart review of the clinical, diagnostic, anamnestic, and demographic features of 151 pregnant women who visited the ward or emergency room of Charité Universitätsmedizin Berlin, Germany, for a neurological consultation due to acute headache from January 1, 2010 to December 31, 2016. Of the 151 patients, 76 (50.3%) underwent brain imaging, with 45 women (59.2%) showing normal results, 21 women (27.6%) showing symptomatic pathological findings, and 10 women (14.2%) showing incidental pathological findings unrelated to headache.
Symptomatic pathological findings included intracranial bleeding (28.6%), CVT (23.8%), PRES (19.0%), acute cerebral infarction (14.3%), and acute sinusitis (14.3%). Half of the 10 incidental pathological findings showed non-specific white matter lesions, with the remaining showing chronic sinusitis (20.0%), chronic cerebral infarction (10.0%), congenital brain cyst (10.0%), and non-specific meningeal enhancement (10.0%).
A number of clinical predictors of pathological findings vs absence of findings were identified, including sudden pain onset (19.0 vs 5.5%, respectively; P =.067), pain intensity >9 on a 0 to 10 scale (43.8 vs 14.3%, respectively; P =.016), and change in consciousness (14.3 vs 1.8%, respectively; P =.030). Seizures were only experienced by patients with symptomatic pathological findings (14.3 vs. 0.0%, respectively; P =.004).
Study investigators conclude that “brain imaging studies may reveal a secondary headache etiology in over one-fourth of pregnant women presenting with acute headache. Some secondary headaches with higher risk during pregnancy like headache attributed to intracranial hemorrhage, ischemic stroke or CVT can be diagnosed only by imaging. Strong pain intensity, change in consciousness and seizures can be considered as predictors for pathological imaging findings in pregnant women suffering from acute headache. In these cases, the rapid completion of an MRI is mandatory.”
Raffaelli B, Neeb L, Israel-Willner H, et al. Brain imaging in pregnant women with acute headache [published online June 11, 2018]. J Neurol. doi: 10.1007/s00415-018-8924-6