Persistent headache in a postpartum patient: the investigation and management

Abstract

Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. CVST is a serious pathology with high mortality if misdiagnosed, but its correct and rapid diagnosis offers the opportunity for early treatment. Cranial magnetic resonance imaging (MRI) is an important modality in the diagnosis of both CVST and intracranial hypotension. The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely.

Headaches in Pregnancy and Postpartum

“…ACOG suggests prompt treatment for central venous sinus thrombosis (CVST) with adjusteddose low-molecular-weight heparin to prevent long-term significant sequelae (171)(172)(173)(174). (CONDI-TIONAL RECOMMENDATION, MODERATE-QUALITY EVIDENCE)…”