TOG: Headaches in Pregnancy

Question 1

what is the most common type of headache in pregnancy,

Answer 1

migraine, tension-type.

Accounts for >90% headaches in pregnancy

Question 2

in what percentage of epidurals does puncture of the dura occur?

Answer 2

0.5-2.5%

Question 3

what is the % chance of a postdural puncture headache with accidental dural puncture?

Answer 3

70-80%

Question 4

what is the cure- rate for postdural puncture headache treated with with blood patch?

Answer 4

60-90%

Question 5

if a postdural puncture headache is left untreated, how long do symptoms typically last?

Answer 5

7-10 days, can last up to 6 weeks

Question 6

what are the red flag signs to look out for in central venous thrombosis?

Answer 6

non-focal neurological symptoms- eg cognitive disturbance

Question 7

what are the classical features of migraine?

Answer 7

unilateral, pulsating, builds up over minutes to hours, moderate to severe intensity, assoc with n&v

Question 8

how does pregnancy alter migraine aura? Why does this occur?

Answer 8

can trigger attacks of aura without headache. Occurs due to high plasma concentration of oestrogen

Question 9

how do triptans work for the treatment of migraine? Are they safe in pregnancy?

Answer 9

triptans cause vasocontriction, inhibit the release of pain-generating neuropetides and bind to serotonergic receptors.
No adverse outcomes seen in women exposed to this drug in pregnancy

Question 10

what prophylaxis for migraines can be considered for migraines?

Answer 10

propranolol 10-40mg- has best evidence for safety in pregnancy TDS. OR amitryptiline lowest dose (25-50mg ON

Question 11

what is the risk of pre-eclampsia in women who suffer with migraine?

Answer 11

2-fold increase risk PET in women with migraine compared to women without

Question 12

what are the characteristics of headache associated with idiopathic intracranial hypertension?

Answer 12

generalised, non-throbbing, aggravated by coughing/ straining
diplopia- 38%, visual loss- 31%, papiloedema

Question 13

what pressure of CSF is diagnostic of intracranial hypertension?

Answer 13

> 20cmH2O

Question 14

what treatment can be given for idiopathic intracranial hypertension?

Answer 14

therapeutic lumbar puncture or acetazolamide 500mg BD

Question 15

What is PRES?

Answer 15

Posterior reversible encephalopathy syndrome

Associated with PET
Oedema posterior circulation in brain
Associated with endothelial damage and loss of autoregulation of blood flow (also seen in Immunosuppressant drug use, nephrotic, sepsis, SLE)

Question 16

What is the incidence of cerebral venous thrombosis in pregnancy and the puerperium in Western countries?

Answer 16

1 in 2500-10,000 deliveries