Severe Headache In Pregnant Women: When To Worry

New Findings by Montefiore and Einstein Researchers Offer First Clinical Recommendations

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Aug 19, 2015, 04:00 ET

BRONX, N.Y., Aug. 19, 2015 /PRNewswire-USNewswire/ -- If a pregnant woman with high blood pressure and no history of headache suddenly develops a headache that quickly gets worse, she could be at risk for pregnancy complications, including preeclampsia, which put both the mother and fetus at risk. These and other findings from a new study conducted by researchers at Montefiore Health System and Albert Einstein College of Medicine of Yeshiva University, offer the first clinical recommendations for making diagnostic decisions about headaches in pregnant women. The study, the largest of its kind, was published online today in the journal Neurology.

"Headaches during pregnancy are quite common, but it is not always easy to distinguish between a recurring, preexisting migraine condition and a headache caused by a pregnancy complication," said lead author Matthew S. Robbins, M.D., director of inpatient services at Montefiore Headache Center, chief of neurology at Jack D. Weiler Hospital of Montefiore, and associate professor of clinical neurology at Einstein. "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 preeclampsia."

Preeclampsia (previously called toxemia) typically occurs during the second or third trimester of pregnancy and may be related to an abnormal interaction of blood vessels that supply the placenta. Symptoms and signs can include high blood pressure, headaches, blurry vision, or abdominal pain, although some patients may have no symptoms. Depending on the severity and the age of the fetus, treatment ranges from bed rest for mild preeclampsia to premature delivery if the condition is severe.

Dr. Robbins and colleagues analyzed records of every pregnant woman with headache who had been referred for a neurological consultation at Montefiore's Weiler Hospital over a five-year period. The study involved 140 women with an average age of 29. A large majority of the patients were Hispanic or African-American, reflecting the makeup of the Bronx population.

Most (91) of the 140 women had primary headaches, 90 percent of which were migraines. Among the 49 patients with secondary headache, 51 percent were diagnosed with pregnancy-related high blood pressure, including the 38 percent of women who had preeclampsia.

The most telling indicator of a secondary headache among pregnant women proved to be high blood pressure. Compared to pregnant women with headache but no high blood pressure, women with headache plus high blood pressure faced a 17-fold increased likelihood that their headaches were caused by some other condition. "In most of these patients, their elevated blood pressure was driven by preeclampsia," said Dr. Robbins.

The researchers found that another red flag for a headache that should be taken seriously was lack of a previous history of headache, which was associated with a five-fold increased likelihood that the headache was secondary to something else. Other warning signs were fever, seizures, and headaches in the absence of phonophobia (sound sensitivity) and psychiatric problems.

The paper is titled "Acute headache diagnosis in pregnant women: a hospital-based study." The other authors are: Constantine Farmakidis, M.D., Ashlesha K. Dayal, M.D., and Richard Lipton, M.D., all at Einstein-Montefiore.

Dr. Lipton serves on the editorial board of Neurology, holds stock options in eNeura Therapeutics and serves as a consultant, advisory board member, or has received honoraria from Allergan, the American Headache Society, Autonomic Technologies, Boehringer-Ingelheim Pharmaceuticals, Boston Scientific, Bristol-Myers Squibb, CogniMed, CoLucid, Eli Lilly, Endo, eNeura Therapeutics, GlaxoSmithKline, Merck, Novartis, NuPathe, Pfizer, and Vedanta Research. Dr. Robbins, Dr. Farmakidis and Dr. Dayal report no conflicts of interest.

About Montefiore Health System
Montefiore is a premier academic health system and the University Hospital for Albert Einstein College of Medicine. Combining nationally-recognized clinical excellence with a population health perspective that focuses on the comprehensive needs of the communities it serves, Montefiore delivers coordinated, compassionate, science-driven care where, when and how patients need it most. Montefiore consists of eight hospitals and an extended care facility with a total of 2,747 beds, a School of Nursing, and state-of-the-art primary and specialty care provided through a network of more than 150 locations across the region, including the largest school health program in the nation and a home health program. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals." Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The health system derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit http://www.montefiore.org. Follow us on Twitter; like us on Facebook; view us on YouTube.

About Albert Einstein College of Medicine
Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2014-2015 academic year, Einstein is home to 742 M.D. students, 212 Ph.D. students, 102 students in the combined M.D./Ph.D. program, and 292 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2014, Einstein received $158 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center—Einstein's founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.

SOURCE Montefiore Health System