After the emotional and physical exhaustion of delivering a baby, the last thing you need is a headache. But a headache in the postpartum period is a common complaint. Hormonal changes, dehydration, anesthesia, and sleep irregularity can all contribute to headache after delivery of your precious newborn.
Usually fluid, rest, relaxation, and an anti-inflammatory, like ibuprofen, can alleviate the discomfort. But, sometimes, headaches in postpartum women last longer than 24 hours, are more severe than usual, and/or are not relieved by typical measures. When this happens, you should to be sure to contact your healthcare provider, as the causes could signal a medical condition specific to the postpartum period — or even be life-threatening.
A Study Examining the Cause of Postpartum Headache
In a study in the American Journal of Obstetrics & Gynecology, researchers from the University of Cincinnati College of Medicine reviewed the outcomes of 95 women with postpartum headache from the years 2000-2005.
Postpartum headache was defined as "the onset of severe unrelenting headache 24 hours from the time of delivery and within 42 days after delivery." Women in this study were either already in the hospital or readmitted after being discharged for a severe headache. Patients not included in the study included women who had a headache during the first 24 hours after delivery, and patients with any known neurologic disease such as a seizure disorder or history of stroke.
The study found that nearly 50% of the women's headaches were either migraines or tension-type headaches. Twenty-four percent were caused by preeclampsia/eclampsia, and sixteen percent were spinal headaches. The other 10% of the patients had more serious brain abnormalities, including bleeding and stroke.
Researchers from the study devised an algorithm for determining the cause and potential danger of headaches in a postpartum woman. While the algorithm is primarily meant for obstetricians and emergency medicine doctors, it's fairly easy to follow and it's always a good idea for patients to be informed of their doctor's decision-making process.
Algorithm for Postpartum Headache
For a detailed image of the algorithm, please see the figure from the article, Postpartum headache: is your workup complete?" Please remember that the information below is not meant to substitute for your doctor's advice.
•Life-Threatening Headache: Imaging of your brain, such as a CT scan or MRI, will be done if there are any neurologic problems or other headache warning signs. Neurologic problems include (not limited to): walking difficulties, blurry vision, or paresthesias.
Examples of rare but dangerous headaches that require immediate medical attention include:
- dural sinus thrombosis
- subarachnoid hemorrhage (requires a lumbar puncture to properly diagnose).
- meningitis (requires a lumbar puncture to properly diagnose).
• Preeclampsia/Eclampsia: Your doctor will check your blood pressure and perform a urinalysis. If you have high blood pressure and protein in your urine, your doctor will treat you for preeclampsia/eclampsia. You may receive medication to bring your blood pressure down and/or medication to prevent seizures, called magnesium sulfate. If your symptoms don't resolve with the above treatment, then your doctor may recommend brain imaging.
• Migraine/Tension/Spinal: After ruling out life-threatening causes of a postpartum headache, as well as serious medical conditions such as preeclampsia, the diagnosis of your headache at this point is probably a migraine or tension-type headache. Pain medication, fluids, and sleep will be recommended. One other diagnosis your doctor will consider if you underwent an epidural for anesthesia during delivery is a spinal headache. In the case of a spinal headache, your doctor would suggest intravenous fluids, caffeine, or even a blood patch. A blood patch entails a surgery, in which your own blood is injected into the puncture site where your epidural was done. This compresses the hole, preventing any further spinal fluid leak.
What Should I Do?
If you experience a postpartum headache, contact your doctor, or page your nurse if you're still in the hospital. There's likely a simple solution, such as sleep, fluids, or a pain medication. However, your doctor will want to make sure there is nothing more serious going on. As a parent, you also want that reassurance so you can obtain quick headache relief and get back to enjoying your newborn.
Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? Am J Obstet Gynecol 2007;196(4):318.e1-7.