Abstract
Objectives Headache disorders are common in pregnancy and the puerperium and imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is occasionally required to rule out secondary causes such as cerebral venous sinus thrombosis that are of increased risk in pregnancy. We aim to determine the incidence and aetiology of headaches that occur in pregnancy and puerperium at Campbelltown Hospital over a 12-month period and the clinical predictors for detecting abnormalities on CT and MRI.
Methods Pregnant and postpartum patients admitted to Campbelltown hospital with headaches between 1st January and 31st December 2020 were identified through medical records by searching appropriate Diagnosis Related Group (DRG) codes. Demographic data, clinical findings, investigations and diagnoses were collected.
Results 115 patients with headaches were identified out of 181 presentations. With 3906 confinements in 2020, the incidence of headaches was 2.94% with the majority in their third trimester (66%) or postpartum (22%). 42 patients (36.5%) had imaging. No patient with a hypertensive disorder had imaging performed and Neurology were involved in 85.7% of cases imaged. Most imaging was normal or non-specific, apart from one case each of pontine stroke, posterior reversible encephalopathy syndrome and compression of the trigeminal nerve. The most common cause of headache was hypertensive disorders (60%) followed by migraines (19.1%).
Conclusions Headaches typically occurred in late pregnancy or postpartum, the majority due to hypertensive disorders. Imaging in those without a known hypertensive disorder was low yield. Future directions are to develop a risk stratification tool to better utilise resources.
