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Secondary headaches in pregnancy could be sign of serious complication

The combination of headaches and high blood pressure in pregnant women could be a sign of pre-eclampsia, according to recently published data in Neurology.

Matthew S. Robbins, MD, director of inpatient services, Montefiore Headache Center, and colleagues, evaluated 140 pregnant women who were referred for neurological consultations from the ED, labor and delivery triage or antepartum units that were presenting with acute headaches.

Matthew S. Robbins

Participants had a mean age of 29 years, with the majority being black (39.3%) or Hispanic (36.4%). Over 75% had previous history of headaches.

Sixty-five percent of women had primary headache disorders and 35% had secondary disorders. Migraines were the most common primary headache disorder (91.2%), and hypertensive disorders were the most common secondary headache disorder (51%).

The combination of headaches and high blood pressure was associated with a 17-fold increase of headaches being caused by an underlying condition, according to a press release. Among women with secondary headaches, 51% were diagnosed with high blood pressure and 38.8% had pre-eclampsia.

Participants with secondary headaches were more likely to lack a history of headaches (P = .0012), have seizures (P = .0015), elevated blood pressures (P = .0001), or fever (P = .014), and have abnormal neurological examinations (P = .014).

“Headaches during pregnancy are quite common, but it is not always easy to distinguish between a recurring pre-existing migraine condition and a headache caused by a pregnancy complication,” Matthew S. Robbins, MD, director of inpatient services, Montefiore Headache Center, said in a press release. “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 pre-eclampsia.” – by Casey Hower

Disclosures: Robbins reports serving on the editorial board for Headache and as a section editor for Current Pain and Headache Reports. He receives royalties for educational activities with the American Headache Society, American College of Physicians, Prova Education, SUNY Downstate, and North Shore-LIJ Hofstra School of Medicine, and book royalties for Headache. Please see the full study for a list of all other researchers’ relevant financial disclosures.