Neurology: Bronx Study Focuses on Pregnancy Headaches

Severe headaches in pregnant women can be a red flag for physicians. These women may be at risk of pregnancy complications including pre-eclampsia.

That means physicians may need to refer them for a neurological consult. A team at Montefiore Medical Center in the Bronx, NY, looked at 140 cases of such women over a five-year period. The study, which the authors said is the largest of its kind, was published online August 19 in the journal Neurology.

Acute headache in pregnancy “often results in diagnostic challenges,” they wrote.

The researchers concluded that most (65%) had a primary headache disorder, most commonly migraine (91.2 %.) Of the 35% of patients who had secondary headache disorders, most (51%) were hypertensive disorders.

“Headaches during pregnancy are quite common, but it is not always easy to distinguish between a recurring, preexisting migraine condition and a headache caused by a pregnancy complication,” said lead author Matthew S. Robbins, M.D., director of inpatient services at Montefiore Headache Center. “Our study suggests that physicians should pay close attention when a pregnant woman presents with a severe headache, especially if she has elevated blood pressure or lack of past headache history. Those patients should be referred immediately for neuroimaging and monitoring for preeclampsia.”

The patients in the study had similar demographics, gestational ages, and most headache features, the team reported. In univariate analysis, secondary headaches were associated with a lack of headache history, seizures, elevated blood pressure, and fever. In this group, 34.7% had an abnormal neurologic examination result.

A large majority of the patients were Hispanic or African-American, reflecting the makeup of the Bronx population.

Most (91) of the 140 women had primary headaches, 90 percent of which were migraines. Among the 49 patients with secondary headache, 51 percent were diagnosed with pregnancy-related high blood pressure, including the 38 percent of women who had pre-eclampsia.

The most telling indicator of a secondary headache among pregnant women proved to be high blood pressure. Compared to pregnant women with headache but no high blood pressure, women with headache plus high blood pressure faced a 17-fold increased likelihood that their headaches were caused by some other condition. “In most of these patients, their elevated blood pressure was driven by preeclampsia,” said Dr. Robbins.

The researchers found that another red flag for a headache that should be taken seriously was lack of a previous history of headache, which was associated with a five-fold increased likelihood that the headache was secondary to something else. Other warning signs were fever, seizures, and headaches in the absence of phonophobia (sound sensitivity) and psychiatric problems.

The paper is titled “Acute headache diagnosis in pregnant women: a hospital-based study.” The other authors are: Constantine Farmakidis, M.D., Ashlesha K. Dayal, M.D., and Richard Lipton, M.D., all at Einstein-Montefiore.