Severe Headache in Pregnant Women: When to Worry

 
     If a pregnant woman with high blood pressure and no history of headache suddenly develops a headache that quickly gets worse, she could be at risk for pregnancy complications, including pre-eclampsia, according to a study published today in the online edition of the journal Neurology.
    The findings offer the first clinical recommendations for making diagnostic decisions about headaches in pregnant women.
   “Headaches during pregnancy are quite common, but it is not always easy to distinguish between a recurring, pre-existing migraine condition and a headache caused by a pregnancy complication,” said lead author Matthew S. Robbins, MD, Montefiore Headache Center, Bronx, New York. “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 pre-eclampsia.”
    For the current study, the researchers analysed the medical records of every pregnant woman with headache who had been referred for a neurological consultation at Montefiore’s Weiler Hospital over a 5-year period. The study involved 140 women with an average age of 29 years. A large majority of the patients were Hispanic or African-American, reflecting the makeup of the Bronx population.
    Most (65%) of the 140 women had primary headaches, 90% of which were migraines. Among the 49 patients with secondary headache, 51% were diagnosed with pregnancy-related high blood pressure, including the 38% of women who had pre-eclampsia.
    The most telling indicator of a secondary headache among pregnant women proved to be high blood pressure. Compared with pregnant women with headache but no high blood pressure, women with headache plus high blood pressure faced a 17-fold increased likelihood that their headaches were caused by some other condition.
    “In most of these patients, their elevated blood pressure was driven by pre-eclampsia,”
    Researchers found that another red flag for a headache that should be taken seriously was lack of a previous history of headache, which was associated with a 5-fold increased likelihood that the headache was secondary to something else. Other warning signs were fever, seizures, and headaches in the absence of phonophobia and psychiatric problems.
SOURCE: Montefiore Medical Center