Headache in pregnancy: Just hormones or a red flag waving

15% of people worldwide are affected by headaches each day. Benign, primary headaches (migraine and tension-type) are most burdensome in women during their reproductive years making headache an exceedingly common reason for presentation to maternity services during pregnancy. Headaches may be hormonally driven. However, they may also herald the onset of serious, life-threatening conditions such as eclampsia or cerebrovascular events which require prompt evaluation and management.

 

This case highlights that even in the absence of typical red flag features of a secondary headache, this should be considered in pregnant woman presenting with atypical symptoms. The differential diagnosis of a headache during pregnancy and the puerperium is broad and requires careful consideration. The decision to further evaluate those presenting with textbook symptoms and neurological signs is relatively straightforward. However, deciding who needs further workup when presenting with headache alone is more complex. Pregnancy increases the likelihood of both primary and secondary headaches, and a new headache during this time should be considered a red flag and prompt further investigation