Department of Neurology with Experimental Neurology- Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Institute of Neuroradiology - Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
J Headache Pain. 2017 Dec 4;18(1):114. doi: 10.1186/s10194-017-0823-1.
Acute headache is one of the most frequent neurological symptoms in pregnant women. The early diagnosis of underlying secondary conditions has a major influence on patient outcome, especially in emergency settings. However, at the time being no well-established guideline for diagnostic evaluation of acute headache during pregnancy exists. In this study, we aimed to characterize acute headache in pregnant women concerning demographic, clinical, and diagnostic features, and to determine predictors of secondary headache.
We analysed retrospectively the data of 151 pregnant women receiving neurological consultation due to acute headache at the Charité Berlin between 2010 and 2016. To assess risk factors for secondary headache in these patients we compared multiple anamnestic and clinical features of the primary and secondary headache group.
57.6% of the patients were diagnosed with primary headache, most common migraine and tension type headache. Concerning secondary headaches, the most common aetiologies were infections (29.7%) and hypertensive disorders (22.0%). The primary and secondary headache group were similar in most anamnestic and clinical features. In multivariate logistic regression analysis, secondary headache history [OR 6.6; 95% CI 1.3-33.1], elevated blood pressure [OR 7.2; 95% CI 2.3-22.6], fever [OR 12.1; 95% CI 1.3-111.0] and abnormal neurological examination [OR 9.9; 95% CI 2.7-36.3] represented independent predictors for secondary headache. Regarding additional diagnostic procedures, abnormal thrombocytes, GOT, GPT and CRP, proteinuria, pathologic results of lumbar puncture and neuroimaging were associated with secondary headache.
Secondary headache disorders are common during pregnancy, occurring in over one third of acute headache cases receiving neurological consultation. Most anamnestic and clinical features may not allow a clear distinction between primary and secondary headaches. Clinicians should pay attention to the presence of secondary headache history, elevated blood pressure, fever and abnormal findings in the neurological examination. Additional investigations, including laboratory tests and neuroimaging, are essential for the diagnostic process.
急性头痛是孕妇最常见的神经科症状之一。对潜在继发疾病的早期诊断对患者的预后有重大影响，尤其是在急诊环境中。然而，目前尚不存在针对妊娠期间急性头痛的诊断评估的既定指南。在本研究中，我们旨在描述孕妇急性头痛的特征，包括人口统计学、临床和诊断特征，并确定继发头痛的预测因素。
我们回顾性分析了 2010 年至 2016 年期间在柏林 Charité 接受神经科咨询的 151 例因急性头痛就诊的孕妇的数据。为了评估这些患者继发头痛的危险因素，我们比较了原发性和继发性头痛组的多项病史和临床特征。
57.6%的患者被诊断为原发性头痛，最常见的是偏头痛和紧张型头痛。继发性头痛中，最常见的病因是感染（29.7%）和高血压疾病（22.0%）。原发性和继发性头痛组在大多数病史和临床特征方面相似。在多变量逻辑回归分析中，继发性头痛病史[OR 6.6；95% CI 1.3-33.1]、血压升高[OR 7.2；95% CI 2.3-22.6]、发热[OR 12.1；95% CI 1.3-111.0]和异常神经检查[OR 9.9；95% CI 2.7-36.3]是继发性头痛的独立预测因素。关于其他诊断程序，异常血小板、GOT、GPT 和 CRP、蛋白尿、腰椎穿刺和神经影像学的病理结果与继发性头痛有关。
继发性头痛疾病在怀孕期间很常见，在接受神经科咨询的急性头痛病例中超过三分之一是继发性头痛。大多数病史和临床特征可能无法明确区分原发性和继发性头痛。临床医生应注意继发性头痛病史、血压升高、发热和神经检查异常的存在。包括实验室检查和神经影像学在内的其他检查对诊断过程至关重要。
