Pregnancy Headache

There is only a very small chance of there being another cause of headache during pregnancy.

Some serious headaches can occur at any time of life and pregnancy is not an exception. The risk of these headaches is not increased during pregnancy.

1. Meningitis
2. Subarachnoid haemorrhage
3. Sinusitis

Other headaches are at a slightly increased risk during pregnancy, and these are usually related to the blood supply of the brain:

These include

1. Venous Sinus Thrombosis
2. Reversible Cerebral Vasoconstriction Syndrome , which usually is accompanied by posterior reversible leucoencephalopathy

These are usually due to pre-eclampsia or eclampsia, and can cause a thunderclap headache often with visual disturbance.

There are characteristic white matter changes (Leuco = white matter, encephalopathy = brain disorder) on MRI brain scans.



3. Low Pressure Headache following Spinal Anesthesia

Low pressure headache following inadvertent Cerebrospinal Fluid leak and may complicate epidural or spinal anaesthesia.

There are very rare reports of air entering the spine during epidural anaesthesia, and this can cause severe headache, nausea and vomiting as the air works it way up into the head - pneumocephalus (pneumo = air, cephalus = of the head).

Air is used to locate the epidural space when trying to position the needle for an epidural anesthetic.

If the needle is in fact in the CSF and not the epidural space (the needle may only be one or two millimetres out of place), air will get into the CSF and migrate up to the brain - causing a terrible headache that is not relieved by lying flat.

4. Cortical Vein Thrombosis

During a low pressure headache, a surface vein on the brain becomes distorted due to lack of support from CSF and subsequently clots off.

This can cause persistent headache after pregnancy. It will usually resolve with anti-coagulation or Aspirin, but cases of more serious stroke have been recorded on a few occasions only.

Breastfeeding Headache can also occur, and is probably under-recognised, but at least it's not serious.

When sexual activity resumes an Orgasm Headache is possible.

If a sudden severe orgasm headache occurs within a few weeks of delivery the reversible cerebral vasoconstriction syndrome should be considered as a potential cause of the headache.

Pregnancy Headache References

Smarkusky L et al. Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.Obstet Gynecol. 2006;108:795-8. (Free Abstract only)

W.S. Bartynski. Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical FeaturesAJNR Am. J. Neuroradiol.2008; 29: 1036-42 (Free Abstract only)

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