Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Imaging of headaches in pregnancy and the puerperium (#71)

Abhishikta Dey 1 2 3 , Tram Nguyen 4 , Annemarie Hennessy 1 5 , Sumana Gopinath 4
  1. Western Sydney University, Campbelltown, NSW, Australia
  2. University of Sydney, Sydney
  3. Obstetric Medicine , Campbelltown Hospital, Campbelltown, NSW, Australia
  4. Neurology, Campbelltown Hospital, Campbelltown, NSW, Australia
  5. Nephrology, Campbelltown Hospital, Campbelltown, NSW, Australia

Background: Headache disorders are common and typically affect women of childbearing age.(1) Most can attributed to primary headaches, such as tension headaches or migraines.(2) However, pregnancy can exacerbate pre-existing neurological conditions and increases the risk of pathological vascular processes such as preeclampsia, cerebral venous thrombosis and many other diagnoses.(3,4) Symptoms can be non-specific it can be challenging to diagnose on clinical grounds alone. Increasingly, computed tomography (CT) and magnetic resonance (MR) imaging modalities are utilised to help with management and prediction of severe outcomes. There are no universally accepted guidelines to determine need for imaging in headaches during pregnancy and the puerperium.(5,6)

Objectives: To determine the incidence of headaches in pregnancy and puerperium at Campbelltown Hospital over a 12-month period. To determine clinical predictors for detecting abnormalities on CT or MR.

Methods: A retrospective clinical audit of pregnant and postpartum patients admitted to Campbelltown hospital with headache from 1st January 2020 to 31st December 2020 was conducted.  Campbelltown Hospital’s medical record was searched for Diagnosis Related Group (DRG) codes for pregnancy or postpartum AND headaches / preeclampsia / hypertensive disorder of pregnancy / intracranial lesion. Demographic data, red flag data, investigations and diagnoses were collected by thorough chart review.

Results: There were 115 patients with headaches and 3906 confinements in 2020. The incidence was 2.94%. Median age was 30 years (range 16 – 45). Nine patients identified as aboriginal (8.49%). Sixty percent of patients had hypertensive disorders.  Majority of patients were in their third trimester (66%) or postpartum (22%). 42 patients had imaging, 33 patients had CTs performed, 15 had MRIs performed. None of the patients with hypertensive disorders had imaging. Everyone that had an MRI was seen by neurology. Most imaging was normal or non-specific, except for pontine stroke, posterior reversible leukoencephalopathy and compression of the trigeminal nerve. Hypertensive disorders were the most common cause of headache, followed by migraine. Treatment consisted of antihypertensives, simple analgesics or anti-emetics. Seventeen percent of patients with a hypertensive disorder had MgSO4 infusions.

Conclusions: Hypertensive disorders were the most common cause for headaches admitted to hospital in pregnancy. Headaches typically occurred in the 3rd trimester or postpartum. Imaging was performed in those with no known hypertensive disorder. There was minimal yield from imaging. The data was limited by its retrospective nature, missing data and poor documentation. A future direction would be to develop a risk stratification tool to better allocate imaging resources.

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  3. Burch R. Headache in Pregnancy and the Puerperium. Neurol Clin. 2019;37(1):31–51.
  4. Digre KB. Headaches During Pregnancy. Clin Obstet Gynecol. 2013;56(2).
  5. American College of Obstetricians And Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 723. Obs Gynecol. 2017;130:e210-6.
  6. Negro A et al. Headache and pregnancy: a systematic review. J Headache Pain. 2017;18(1):106.