Two young women with chronic daily headache and cognitive impairment: why we need to ask about headache in the postpartum period

Abstract

Headache, which has a variety of causes, is a common and disabling complaint following childbirth. An important aetiology not to be missed is headache from epidural spinal anaesthesia, known as postdural puncture headache (PDPH), which has been reported in upwards of 85% of pregnant women and is a manifestation of intracranial hypotension from leakage of cerebrospinal (CSF) fluid through a dural tear. The common presenting symptom of PDPH is head pain occurring when a patient is in an upright position that resolves with recumbency. Other neurological issues associated with intracranial hypotension can include cranial nerve palsies, encephalopathy and Parkinsonism. We present two cases of persistent PDPH after pregnancy with secondary cognitive impairment. A review of the clinical manifestations, neuroimaging findings and treatment for PDPH will be presented. Better recognition of this disorder by obstetricians, physicians and anaesthetics will help to reduce the considerable morbidity this syndrome can produce in young mothers.

Research process, recap, and prediction of Chiari malformation based on bicentennial history of nomenclature and terms misuse

“…the term False Chiari was rst used in 2013 by Beams et al 150 to describe two puerperae with tonsillar herniation due to intracranial hypotension. Since then, it often used together with True Chiari for comparative purposes 13,151,152 .…”

Chronic headaches related to post-dural puncture headaches: a scoping review

“…Based on the case reports outlined in Supplementary Table S2, conservative treatment including pharmacotherapy and bed rest are generally of limited efficacy in patients with chronic headache after dural puncture. 29,30,32 However, this may be a result of selective reporting of only the most severe and recalcitrant cases.…”

The Relationship between the Phases of the Menstrual Cycle on the Incidence and Severity of Headache after Spinal Anesthesia

“…2 This headache has a pulsating nature; it is exacerbated by sitting and is better when sleeping; it is felt more in the forehead and behind the head and in severe cases with symptoms such as neck stiffness, shoulder pain, low back pain, hearing loss, tinnitus, dullness, dizziness nausea, and vomiting. 3 The headache falls in 24% of cases within 48 hours, more than 50% in 4 days and 72% in 1 week. Studies have showed that various factors such as needle shape, size, sex and age of the patient, duration of surgery, spinal anesthesia history, and headache history play an important role in complications.…”