Headache During Pregnancy: When to Investigate Further

Based on a new study published in Neurology, researchers have developed the first clinical recommendations for making diagnostic decisions regarding headaches in pregnant women. The results include suggestions on when clinicians should refer patients for neuroimaging and monitoring for preeclampsia.

Matthew S. Robbins, MD, director of inpatient services at Montefiore Health Center, and colleagues analyzed records from 140 pregnant women (average age 29) who had been referred for a neurological consultation over a five-year period. A total of 91 women had primary headaches, 90% of which were migraines; among those with secondary headache. Approximately 51% were diagnosed with pregnancy-related hypertension, including 38% who had preeclampsia.

Compared to pregnant women with headache but no hypertension, women with headache plus hypertension had a 17-fold increased likelihood that their headaches were caused by some other condition. The elevated blood pressure was driven by preeclampsia in most of these cases. A lack of a previous history of headache was associated with a five-fold increase in headache secondary to something else, while other warning signs were fever, seizures, and headaches in the absence of phonophobia (sound sensitivity) and psychiatric problems.

Robbins added that “our study suggests that physicians should pay close attention when a pregnant woman presents with a severe headache, especially if she has elevated blood pressure or lack of past headache history. Those patients should be referred immediately for neuroimaging and monitoring for preeclampsia.”

Reference

1. Robbins MS et al. Neurology. 2015; doi:10.1212/WNL.0000000000001954. 

This article originally appeared on MPR