This article provides an overview of the diagnosis and management of primary and secondary headaches that may occur during pregnancy and postpartum. Headache presenting in pregnancy is of significant concern to the affected woman. Quick and correct diagnosis leads to the optimal management, minimizing risks to the pregnancy.
Several strategies have been developed to distinguish secondary headaches that need urgent assessment and management from benign primary and secondary headaches and to minimize the risk of misdiagnosis. Recent guidelines for the drug treatment of headaches are considered in the context of updated information on the safety of drugs in pregnancy and lactation.
Primary headaches are common and typically improve during pregnancy. Management during pregnancy and lactation is similar to management in the nonpregnant state, with a few exceptions. Secondary causes of headache that are more likely to occur during pregnancy include cerebral venous thrombosis, posterior reversible encephalopathy syndrome resulting from eclampsia, post–dural puncture headache, stroke, and pituitary apoplexy.
Address correspondence to Professor E. Anne MacGregor, Barts Sexual Health Centre, St Bartholomew’s Hospital, London EC1A 7BE, United Kingdom, firstname.lastname@example.org.
Relationship Disclosure: Professor MacGregor has acted as a paid consultant to and/or her department has received research funding from Addex Therapeutics; Allergan, Inc; AstraZeneca; Berlin-Chemie AG; BTG International Ltd; Endo Pharmaceuticals Inc; GlaxoSmithKline; the Menarini Group; Merck & Co, Inc; POZEN Inc; and UniPath.
Unlabeled Use of Products/Investigational Use Disclosure: Professor MacGregor discusses the use of several drugs for the treatment of headaches, none of which are labeled by the US Food and Drug Administration for use in pregnancy.