Headache in Pregnancy, the Puerperium, and menopause

Abstract

Headache is a neurologic disorder that displays gender dichotomy. It is well established that there is a strong link between migraine headache and sex hormones, specifically estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy, and menopause. Furthermore, the epidemiology of headaches during pregnancy and the postpartum period is very distinct from that in males or nonpregnant females, in part due to the hemodynamic and hematologic changes that occur during pregnancy. These changes put women at higher risk for cerebral venous thrombosis, hemorrhagic stroke, and hypertensive disorders of pregnancy like preeclampsia, eclampsia, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. Headache in pregnancy and the puerperium can be a cause of heightened anxiety in most women, who are concerned not only about the effect of the headache itself on the pregnancy but also about the effect of the treatment options on the pregnancy and the fetus. In this review, we discuss the latest literature on type and distribution of headaches during pregnancy and the postpartum period, and provide a digestible overview of the safety profile of commonly used abortive and prophylactic medications. We also discuss important considerations when treating migraine during menopause.

Headaches in Pregnancy and Postpartum

“…Central venous sinus thrombosis affects one per 2,500–10,000 pregnancies and is more common in women with an underlying thrombophilia (78). It is most likely to occur in the third trimester or postpartum period and presents as a constant, nonspecific headache that can be associated with seizures and focal deficits.…”

The effect of postdural puncture headache on pre-existing and new-onset headaches after cesarean section: A retrospective study

“…Following pregnancy, where hemodynamic and hematological changes are evident, the return to normal physiology occurs during the puerperal period. This is found to be closely related to headaches [ 15 , 16 ]. Our results reveal headache rates similar to the previous studies in both PCS and PG periods, both in the spinal group without PDPH and in the general anesthesia group, which can be attributed to the fact that our patients' post-cesarean period headache inquiries were made after three months when the hormonal fluctuation decreases.…”

Don’t Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review

“…The postpartum is a period characterized by a hypercoagulable state. Management of headache during pregnancy and lactation is largely reliant on a risk/benefit equilibrium, as many medications can produce adverse effects in the newborn [39].…”