Stella Caroline L, Jodicke Cristiano D, How Helen Y, Harkness Ursula F, Sibai Baha M
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
Am J Obstet Gynecol. 2007 Apr;196(4):318.e1-7. doi: 10.1016/j.ajog.2007.01.034.
Headache is a common finding in the postpartum period, and there are limited data describing the cause and treatment of women with postpartum headache. Our objective was to describe our experience with women who were hospitalized for postpartum headache and to develop a management algorithm for these women.
Data for 95 women with headache >24 hours after delivery from 2000-2005 were reviewed retrospectively. Maternal assessment included an evaluation for benign and serious causes of headache that included preeclampsia, dural puncture, and neurologic lesions. Neurologic imaging were performed on the basis of initial neurologic findings and clinical course. Outcomes that were studied included cause, a need for cerebral imaging, neurologic findings, maternal complications, and long-term follow-up evaluations.
The mean onset of headache was 3.4 days (range, 2-32 days) after delivery. Tension-type/migraine headache was the most common cause (47%). Preeclampsia/eclampsia and spinal headache comprised 24% and 16% of cases, respectively. Anesthesia evaluation was required in 15 patients because of suspected spinal headache; blood patch was required in 12 of these patients. Cerebral imaging was performed in 22 patients because of focal neurologic deficits and/or failure to respond to initial therapy; 15 of these women (68%) had abnormal findings. Ten patients had serious cerebral pathologic findings, such as hemorrhage, thrombosis, or vasculopathy. There were no deaths; 2 women had minor residual neurologic damage on follow-up evaluation.
The evaluation of persistent headaches that develop >24 hours after delivery must be performed in a stepwise fashion and requires a multidisciplinary approach. Preeclampsia should be considered initially in women with hypertension and proteinuria. Normotensive women should be evaluated initially for tension-type/migraine headache or spinal headache. Patients with headache that is refractory to usual therapy and patients with neurologic deficit require cerebral imaging to detect the presence of life-threatening causes.
头痛是产后常见的症状，而关于产后头痛女性的病因及治疗的数据有限。我们的目的是描述我们对因产后头痛住院的女性的治疗经验，并为这些女性制定管理方案。
回顾性分析了2000年至2005年间95例产后24小时后仍有头痛症状的女性的数据。对产妇的评估包括对头痛的良性和严重病因进行评估，这些病因包括先兆子痫、硬膜外穿刺和神经病变。根据最初的神经学检查结果和临床病程进行神经影像学检查。研究的结果包括病因、脑部成像的必要性、神经学检查结果、产妇并发症以及长期随访评估。
头痛的平均发作时间为产后3.4天（范围为2至32天）。紧张型/偏头痛是最常见的病因（47%）。先兆子痫/子痫和脊髓性头痛分别占病例的24%和16%。15例患者因疑似脊髓性头痛需要进行麻醉评估；其中12例患者需要进行血液补片治疗。22例患者因局灶性神经功能缺损和/或对初始治疗无反应而进行了脑部成像；其中15名女性（68%）有异常发现。10例患者有严重的脑部病理结果，如出血、血栓形成或血管病变。无死亡病例；2名女性在随访评估中有轻微的神经功能残留损伤。
对于产后24小时后出现的持续性头痛，必须采取逐步评估的方式，并需要多学科方法。对于有高血压和蛋白尿的女性，应首先考虑先兆子痫。血压正常的女性应首先评估是否为紧张型/偏头痛或脊髓性头痛。对常规治疗无效的头痛患者和有神经功能缺损的患者需要进行脑部成像，以检测是否存在危及生命的病因。
