the postpartum woman: horses or zebras?
1Women’s and Children’s Hospital, North Adelaide, SA, Australia
Background: Headache in the postpartum woman is a common complaint; fortunately the majority
have a benign cause (1-2).
The infrequency of serious underlying pathology may delay necessary
investigations, however identification of a sinister cause is essential to
ensure optimal outcomes for women.
Aims: To highlight ‘red flags’ in the presentation
of postpartum headache which warrant further investigation.
Methods: A series of three patients presenting with
headache in the postpartum period is described.
Each patient was found to have an uncommon cause (a so-called ‘zebra’);
the reported cases include vertebral artery dissection, intra-cranial
haemorrhage and postpartum angiopathy. A
review of the literature pertaining to each of the three diagnoses was
Results: Each patient
presented with severe headaches, and with specific features which ultimately triggered
radiological investigation and diagnosis.
Confounding issues (e.g. concomittent hypertension) and unfamiliarity
with the pathologies contributed to delays in imaging and diagnosis; this was
also an issue highlighted in the literature.
Conclusions: Women with headache in the postpartum period
in the presence of
neurological deficits require thorough neurological examination with the use of
imaging. Any new persistent or recurring
headache without adequate response to simple therapies should also be
investigated for a more sinister cause.
1. Grant EN, Wang
J, Gelpi B, Wortman A, Tao W. Diagnosing and managing peripartum headache.
Proc(Bayl Univ Med Cent). 2015;28(4):463-465
2. Block S, Biller J. Neurology of Pregnancy. In: Biller J, Ferro JM, editors.
Handbook of clinical neurology. Vol 11(3rd series). Elsevier; 2012