2026 SOAP Annual Meeting

Diagnostic Challenges of Postpartum Headache after Neuraxial Analgesia in a Parturient with a Reported History of Idiopathic Intracranial Hypertension

Background

uPostpartum headache is common but includes both benign and life-threatening etiologies

uPost-dural puncture headache (PDPH) is frequently considered after neuraxial analgesia

uPatients with obesity, hypertensive disorders, or intracranial pathology increase diagnostic complexity

uPremature attribution to PDPH may delay recognition of serious conditions such as:

uPreeclampsia

uCerebral venous sinus thrombosis (CVST)

uPosterior reversible encephalopathy syndrome (PRES)

uIntracranial hemorrhage

Case

uPatient / Peripartum Course

u24-year-old G3P2 at 37+4 weeks; Class III obesity, preeclampsia

uReported history of Idiopathic intracranial hypertension

uLabor epidural placed

uPostpartum day 0: severe headache, initially positional

uClinical Evolution

uMinimal response to conservative therapy

uHeadache became non-positional

uConcern for preeclampsia

uKey Decision Point: Atypical features → PDPH felt unlikely; Epidural blood patch deferred

uImaging revealed (PPD 0 – 2)

uPPD2: generalized seizure → anticoagulation + anticonvulsants

uDischarged PPD10 after improvement w/outpatient f/u

Teaching Points

uConsider horses first – but do NOT forget the zebras

uEvolution of symptoms is a key red flag

uCritical diagnoses include:

uCerebral venous sinus thrombosis

uPosterior reversible encephalopathy syndrome

uIntracranial hemorrhage

uAvoid anchoring bias — reassessment and multidisciplinary input are essential

2026 SOAP Annual Meeting

Diagnostic Challenges of Postpartum Headache after Neuraxial Analgesia in a Parturient with a Reported History of Idiopathic Intracranial Hypertension

Poster Presenter

Authors

Affiliations

Part of Topic