FORT MYERS, FLA. — The majority of postpartum headaches are primary headaches, and many go untreated, a large study suggests.
About 39% of 985 postpartum women in the prospective cohort study developed a postpartum headache. Primary headaches, such as tension or migraine headaches, were nearly 20 times more frequent than secondary headaches, such as postdural puncture headaches, Eric Goldszmidt, M.D., reported in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.
In fact, migraine and tension headaches accounted for about 73% of all headaches in the study, and musculoskeletal and cervicogenic headaches accounted for about 15%. Postdural puncture headaches accounted for only 4.5%, and the remaining headaches were of an undetermined type, said Dr. Goldszmidt, staff anesthetist at Mount Sinai Hospital, Ontario, and a lecturer at the University of Toronto.
Development of postpartum headache and/or neck and shoulder pain was evaluated via interview and chart review at 3 days and 1 week post partum, and patients were instructed to call if headache developed after that time.
Headache diagnosis was confirmed using an algorithm based on International Headache Society criteria, and risk factors for postpartum headache were identified. Women with known inadvertent dural puncture were at extremely high risk of postpartum headache (adjusted odds ratio 6.4), as were those with a history of headaches (adjusted odds ratio of 1.6 in those with 1–12 headaches per year, and 2.3 in those with more than 12 headaches per year), Dr. Goldszmidt said.
Age slightly increased headache risk with each year. Multiparity also was a significant risk factor for postpartum headache.
Most headaches in this study developed about 3 days after discharge, suggesting that many postpartum headaches might go unreported, untreated, and that the incidence of postpartum headaches is underestimated, he said in an interview.
“Postpartum headaches may be responsible for some discomfort and anxiety that is treatable,” he said.
Of note, postdural puncture headaches accounted for only 21% of all headaches with postdural symptoms—particularly pain relief when supine, which has been considered diagnostic for postdural puncture headaches.
The high incidence of primary headaches with postdural symptoms may confound the diagnosis of postdural puncture headaches, he said.