Скачать или смотреть What you need to know about headache in pregnancy

From ACOG:
PRIMARY HA:
The three primary headache disorders (migraine, tension-type, and cluster) differ in their symptomatology.

Tension-type headaches are bilateral with mild to moderate, nonpulsating, pressure-like pain. These headaches, which can last from 30 minutes to 7 days, are rarely associated with mild nausea without emesis, occasionally have either photophobia or phonophobia but not both, and are not aggravated by routine physical activity.
They typically respond to over-the-counter analgesics.

Migraine attacks typically start with prodromal symptoms, such as fatigue, photophobia, phonophobia, difficulty concentrating, yawning, mood changes, neck stiffness, aversion to touch, food cravings and changes in urinary frequency, that are highly predictive of an imminent headache. Nausea can also begin during the prodromal period. These prodromal symptoms, which can last for 24–48 hours, either stop with the onset of pain, or continue into the headache pain phase. Twenty to thirty percent of women also have aura, which is more commonly visual, but can be sensory, motor, speech, or brain stem. Onset of throbbing, unilateral, moderate to severe head pain occurs at the end of the prodromal symptoms. Without treatment, migraine pain phase can last up to 72 hours.

SECONDARY HA:
Can be dangerous to miss and thus should prompt a lower threshold for investigation. Pregnancy increases the risk for headaches from secondary causes, such as preeclampsia, stroke, benign intracranial hypertension, and enlarging pituitary adenomas.

Features of a secondary headache that warrant prompt attention include “thunderclap” headache, rapid onset, high blood pressure, visual changes, neurologic deficits or altered consciousness, vomiting, and fever.

Red Flags:
•Rapid onset or change from baseline
•Severe pain or “thunderclap” headache
•Elevated blood pressure •Fever
•Gestational age third trimester
•Focal neurologic deficits
•Altered consciousness
•Laboratory abnormalities

Timely imaging is important for detecting the appropriate treatment and preventing the possible development of neurologic deficits.

#pregnancy #headache

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