April 11, 2018

Classifying Postpartum Headache

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Originally posted on March 21, 2018

Research from Headache finds new data on women seeking treatment for acute postpartum headache.

Nearly half of all women experience headache within the first month of giving birth due to unique hormonal and biological changes that take place during and after pregnancy. Sudden dips in estrogen, hypercoagulability, and endothelial dysfunction increase the likelihood of both primary and secondary headache disorders during the postpartum period, creating a diagnostic challenge for many clinicians. More often than not, postpartum women present primary headache disorders like migraine and tension-type headache, but a recent study published in Headache found conflicting results.

Primary vs. Secondary Postpartum Headache

The study titled A Hospital Based Retrospective Study of Acute Postpartum Headache1 by Angeliki Vgontzas, MD and Matthew Robbins MD, FAHS analyzed information from postpartum women reporting acute headache at Montefiore Medical Center in New York City. The study was conducted to improve the understanding of what factors can be associated with secondary versus primary headache when presented during the period. Results found that of the 63 postpartum women diagnosed with headache, 46 were experiencing a secondary headache.

The secondary headaches observed most commonly featured post-dural puncture headache (PDPH), which can occasionally occur due to the administration of epidural anesthesia. The second most common feature was preeclampsia. Preeclampsia is a pregnancy complication that causes women to present high blood pressure, and often headache. If left untreated, it can cause seizures and more dangerous outcomes.

Contrary to these findings, secondary headache comprised only 35% of diagnoses in contemporaneous acute headache consultations during pregnancy at the institution. According to Angeliki Vgontzas, MD, Headache Fellow at John Graham Headache Center at Brigham and Women’s Faulkner Hospital at Harvard Medical School, the results of the study contradict population statistics for postpartum headache as well.

“The majority of headaches that take place in the postpartum period are not secondary headache,” said Vgontzas. “What this indicates to me, is that women that are seeking help for their headache in the postpartum period probably can identify that something feels different.”

A Focus on Maternal Health

Vgontzas believes that this study may indicate that new mothers seeking treatment are aware of the subtle differences between their secondary headache and those that they have experienced in the past. Headache often goes under-reported during the postpartum period, in favor of taking care of their newborn. Vgontzas postulates that it’s more common for women to seek the help of a medical professional when they feel that their symptoms are different or more severe, meaning physicians should consider further testing and monitoring.

“I think many physicians feel uncomfortable with treating any medical conditions during and after pregnancy, especially headache,” said Vgontzas. “I think that it’s important to be open to seeking the advice of a headache specialist during that time.”

Maternal health is becoming a rising concern in the U.S. An investigation on maternal mortality found that more American women are dying of pregnancy-related complications than in any other developed country. The results of this study highlight the potential role of clinicians who assess pregnant and postpartum women with headache in combating this disturbing statistic. If a patient is pregnant or is considering family planning in the future, it is important to advise them on these risks. Advanced warning and open communication is crucial in advocating for maternal health during the postpartum period.

The American Headache Society is committed to keeping its members up to date on the most innovative and meaningful advancements in the realm of headache medicine. One of many initiatives to support that mission is our publication of Headache: The Journal of Head and Face Pain, published ten times per year, which highlights the latest findings in the realm of headache medicine research. Enjoy access to the full catalog of content plus a print subscription included with an American Headache Society Membership. Click here to become a member today.

  1. Vgontzas, A. and Robbins, M. S. (2018), A Hospital Based Retrospective Study of Acute Postpartum Headache. Headache: The Journal of Head and Face Pain. doi:10.1111/head.13279

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