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Review
. 2015 Mar;16(2):291-301.
doi: 10.5811/westjem.2015.1.23688. Epub 2015 Feb 25.

Headache in pregnancy: an approach to emergency department evaluation and management

Jessica C Schoen  1 , Ronna L Campbell  2 , Annie T Sadosty  2
Affiliations
Review

Headache in pregnancy: an approach to emergency department evaluation and management

Jessica C Schoen et al. West J Emerg Med. 2015 Mar.

Abstract

Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy.

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Figures

Figure
Figure
Suggested approach to evaluation of headache in a pregnant patient. Leading differential diagnosis and/or availability of advanced imaging should determine the order of laboratory evaluation, lumbar puncture, and/or MRV/MRA. Additional laboratory studies may be obtained if indicated based on differential diagnosis. H&P, history and physical; COHgb, carboxyhemoglobin; CO, carbon monoxide; CT, computed tomography; CBC, complete blood count; LFT, liver function test; IIH, idiopathic intracranial hypertension; diff, differential; SAH, subarachnoid hemorrhage; MRV, magnetic resonance venogram; MRA, magnetic resonance angiogram; CVT, cerebral venous thrombosis; CAD, carotid artery dissection; VAD, vertebral artery dissection; PA, pituitary apoplexy; BP, blood pressure; GA, gestational age
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