Postpartum Headache

Postpartum headache is the complaint of cephalic, neck, or shoulder pain occurring during the first 6 weeks after delivery. The overall incidence of postpartum headache has not been determined in a prospective study. However, information is available from a prospective evaluation of women during the first week postpartum1 and from a prospectively collected database that recorded symptoms during pregnancy and the first week after delivery.2 Among 985 women in the prospective evaluation, the incidence of headache in the first week postpartum was 38.7%.1 The median time from delivery to onset of symptoms was 2 days, and the median duration of headache was 4 hours. Benhamou et al.2 examined information collected on pregnant women who delivered at their institution during a 2-year period; exclusion criteria included recognized dural puncture, preterm delivery, multiple gestation, and/or elective cesarean delivery. Headache was reported by 12% of 1058 patients who had epidural anesthesia without dural puncture and by 15% of 140 patients who delivered without epidural anesthesia. Post–dural puncture headache (PDPH) is one of the most common postpartum complications of neuraxial anesthesia. However, physicians and nurses should be aware that dural puncture is only one of many causes of postpartum headache (Table 31-1). Difficult diagnostic problems may require the opinion of a neurologist. The purpose of this chapter is to discuss the differential diagnosis of postpartum headache and of PDPH in particular.