Acute Headache in Pregnancy/Postpartum
-Migraine can be common in pregnancy, especially for patients with a prior history of migraine, though in general women tend to experience improved frequency during pregnancy
-It is always important to consider secondary headaches in pregnancy and postpartum, so make sure to do a thorough headache history and exam, and use your clinical judgement!
-Some diagnoses not to miss: CVST, pre-eclampsia/eclampsia, PRES, pituitary apoplexy, stroke, SAH, RCVS, IIH
-MRI is the imaging modality of choice to evaluate for secondary headaches (noncontrast!)
Some Treatment Options for Status Migrainosus in Pregnancy:
-Make sure to ALWAYS speak to the patient’s OB before starting treatment, to make sure OB is okay with the therapy recommendations!
-Acetaminophen + metoclopramide 10mg IV, can repeat
-Magnesium sulfate 1g IV over 30min-1h
-Nonpharmacologic management - warm compresses, relaxation/medication, PT/stretching, lidocaine nerve blocks
-Consider noninvasive supraorbital nerve stimulator (ie cefaly device) for long term prevention/acute attack treatment