Boston Medical Center, Department of Neurology, One Boston Medical Center Pl, Boston, MA 02118, United States of America.
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Rd, 2(nd) Floor, Boston, MA 02115, United States of America.
Am J Emerg Med. 2023 Oct;72:16-19. doi: 10.1016/j.ajem.2023.07.001. Epub 2023 Jul 7.
Headaches during pregnancy and the post-partum period may be due to either an exacerbation of a pre-existing neurological presentation, a new pregnancy-related process, or a non-pregnancy related condition. Key physiologic changes during pregnancy and the post-partum period contribute to the vulnerability of this patient population and the increased risk of complications.
Review causes of headaches in pregnant and post-partum patients as well as neuroimaging techniques performed.
Headaches are a common complaint for pregnant and post-partum patients. For pregnant patients, a range of serious causes must be considered including cerebral venous thrombosis, posterior reversible encephalopathy syndrome and stroke. Primary headaches are responsible for most post-partum headaches, however other causes also include pre-clampsia, cerebral venous thrombosis and post-dural headache. Determining the optimal imaging technique in this vulnerable population remains a challenge given the scarce guidelines.
The greatest difficulty while evaluating pregnant and post-partum patients presenting with an acute headache in an emergency setting is to determine whether the headache is due to a primary disorder such as migraines or is secondary to an underlying, sometimes serious pathology. The following review explores evidenced-based diagnosis of headache in this particular setting.
怀孕期间和产后出现的头痛可能是由于先前存在的神经学表现恶化、与妊娠相关的新过程或与妊娠无关的情况引起的。怀孕期间和产后的关键生理变化导致了这一患者群体的脆弱性，并增加了并发症的风险。
回顾妊娠和产后患者头痛的原因以及进行的神经影像学技术。
头痛是妊娠和产后患者常见的主诉。对于妊娠患者，必须考虑一系列严重的病因，包括脑静脉血栓形成、可逆性后部脑病综合征和中风。原发性头痛是大多数产后头痛的原因，但其他病因还包括先兆子痫、脑静脉血栓形成和硬脑膜后头痛。鉴于指南稀缺，在这个脆弱的人群中确定最佳的成像技术仍然是一个挑战。
在急诊环境中评估出现急性头痛的妊娠和产后患者时，最大的困难是确定头痛是由于原发性疾病，如偏头痛，还是继发于潜在的、有时是严重的病理。以下综述探讨了在这一特定环境中基于证据的头痛诊断。
