Headache

Maternal risks
Headache during pregnancy are extremely common. The most common
categories are migraine and tension-type. Although a new-onset headache
during pregnancy is most likely either a migraine or tension-type, it may be the
first manifestation of an intracranial process that needs immediate attention.
Such conditions include aneurysm rupture, AVM, intracranial hypertension,
cerebrel ischemia, cerebrovenous thrombosis, meningitis, sinusitis, and
intracranial masses. In addition, benign intracranial hypertension or psudotumor
cerebri may be seen with pregnancy, but it is uncommon. Patients receiving
spinal or epidural analgesia or anasthesia may experience a spinal headache
during the postpartum period.
Evaluation of the pregnant patient with headache represents a clinical
challenge. The ailments prevalence and typically benign nature make it
desirable to minimize costs by limiting diagnostic testing while being certain to
promptly diagnose uncommon but more serious conditions. The medical history
suggestive of migraine headache, a normal neurologic examination, and
resolution with simple measures, the patient may be followed clinically. If a
new-onset headache severe enough to justify an emergency room visit or a
preexiting condition becomes progressively worse, an aura is present, or a
neurologic deficit is identified, diagnostic evaluation is indicated.

Migraine
Maternal and Fetal Risk
Migraines can be subdivided inti those with or without an aura. The aura is
described as a presence of transient neurologic signs or symptoms before,
during, or even after the headache. The pain is often associated with nause,
vomiting, and photophobia. Sleep often provides relief. As with headaches in
general during gestation, the course of migraines is variable. A decrease in
pregnancy is seen in 50% to 80% of women, particulary in the third trimester.
Those patients experiencing migraines associated with menstruation are
especially likely to show improvement. The headache tend to worsen
postpartum, with as many as 40% of patients complaining of pain during this
time. Migraine recurred during the puerperium in 4,5% of patients, however,

and an aura may initially appear during this time period. No demonstated
adverse fetal outcome is associated with migraines.

Management options
Prenatal, Labor, Delivery, and Postnatal
A carefully obtained histori and physical exam are essential. With a prior
personal or family history of migraine and a typical presentation, no further
investigation is needed. New-onset migraines repressent a diagnosis of
exclusion. In the abscence of a past history or with focal neurologic findings,
neuroimaging studies such as brain CT or MRI are indiciated. It is desirable to
minimize abdominla and pelvic exposure to x-rays and avoid