Predictors of Headache Before, During, and After Pregnancy: A Cohort Study

Abstract

Objective The present study endeavored to identify predictors of headache during pregnancy, shortly after delivery, and at 8-week follow-up. Background Many women suffer from headaches during pregnancy and the postpartum period. However, little is known about factors that predict headache surrounding childbirth. Methods Secondary analysis of longitudinal cohort study of 2434 parturients hospitalized for cesarean or vaginal delivery in four university hospitals in the United States and Europe. Data were gathered from interviews and review of medical records shortly after delivery; 972 of the women were contacted 8 weeks later to assess persistent headache. The primary outcome measures were experiencing headache during pregnancy, headache within 72 hours after delivery, and headache at 8 weeks after delivery. Results Of the parturients, 10% experienced headache during pregnancy, 3.7% within 72 hours after delivery, and 3.6% at 8 weeks post delivery. Compared to those without a history of headache, a history of headache prior to pregnancy was the strongest predictor of headache during pregnancy (9.8% versus 23.5%; RR 2.4; 95% CI: 1.4 to 4.0). Experiencing headache during pregnancy (adjusted HR 3.8; 95% CI: 2.4 to 6.2) and receiving needle-based regional anesthesia for pain treatment (adjusted HR 2.2; 95% CI: 1.1 to 4.5) were independently associated with headache within 72 hours after delivery with event rates of 11.1% and 10.5%, respectively. Compared to those without such a history, headache before pregnancy was significantly associated with experiencing headache 8 weeks after delivery (4.0% versus 23.8%; RR = 6.0; 95% CI: 2.0 to 8.0), but headache during pregnancy or shortly after delivery was not. Several other psychosocial predictors (e.g., somatization, smoking before pregnancy) were statistically associated with at least one headache outcome. Conclusions A history of headache prior to pregnancy is a strong predictor of headache during and after pregnancy, the latter independent of but compounded by spinal injection. Physicians should attend to prior headache history when making decisions about pain management during and after childbirth. As the lack of formal ICHD-II headache diagnoses is a limitation of this study, future longitudinal studies should replicate the present design while including headache subtyping consistent with ICHD-II nosology.

Headache and pregnancy: a systematic review

“…MA can develop new aura symptoms during gestation [ 24 , 25 ], as pregnancy may trigger attacks of aura without headache as well [ 26 ]. In less frequent cases, hemiplegic migraine makes the differential diagnosis very difficult, especially in the third trimester [ 27 , 28 ]. Therefore, we can easily understand why transient neurologic symptoms during pregnancy are more common among pregnant women with migrainous headache than in those without headache or with non-migrainous headache [ 15 ].…”

Migraine in Women: What Specificities? A Review

“…A large longitudinal cohort study of 2434 pregnant women showed that those with a history of headache prior to pregnancy were at greater risk of experiencing headache during pregnancy [37]. There are many available treatment options for migraine during pregnancy/ lactation, so patients can be reassured that they will not suffer in pain during pregnancy.…”

Headache in pregnancy

“…У нерожавших ГБ чаще и интенсивнее, чем у рожавших [37]. Наличие ГБ до беременности является важным предиктором ее развития во время или после беременности [38].…”