Diagnosing causes of headache within the postpartum period.
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Resumo
BACKGROUND
Headache is one of the most common symptoms following delivery and the underlying cause may be benign or life threatening. Identification of the cause of headache in the postpartum period can be challenging and relies on a comprehensive history and thorough examination, with particular focus on the presence or absence of neurological signs, which may suggest a more serious diagnosis (Nelson-Piercy 2010 ). However, through clinical experience and research, we have noted that post-partum headache is significantly under-recognised and treated (Goldszmidt et al. 2005 ).
OBJECTIVE
To ensure a standardised approach to the management of patients presenting with postpartum headache, we sought to introduce a diagnostic tool for postpartum headache.
METHODS
This was a literature review combined with a postpartum headache case example that occurred within our institution in 2015. Risk factors and potential clinical failures from the case were noted and compared to the literature.
RESULTS
Our case is a 28-year-old woman who developed a postpartum headache following spontaneous vaginal delivery. Of note, the patient had an epidural inserted in labour for analgesia. Initially, systemic and neurological examinations were normal and the patient was discharged home with simple analgesics and a diagnosis of tension-type headache. She represented with worsening headache, pyrexia and signs of meningism. Lumbar puncture confirmed a diagnosis of bacterial meningitis caused by Haemophilus influenzae. She was treated with IV ceftriaxone and discharged home without any long-term sequelae. In an attempt to improve recognition of post-partum headache, especially rare causes such as meningitis, NHS Tayside has chosen to adopt the PARTUM mneumonic (Lim et al. 2014 ). Pressure (blood pressure for pre-eclampsia/eclampsia) Anaesthetic (post-dural puncture headache) Reversible (vasoconstriction syndrome) Thrombosis (cerebral venous sinus thrombosis, ischaemic stroke) Use your brain (there are so many other causes of headache) Migraine (Lim et al. 2014 ). PARTUM was first devised in 2014 as part of a research paper published by the Journal Practical Neurology (Lim et al. 2014 ). The aim of the mnemonic is to allow the treating physician a basic list of postpartum headache causes to use as a working diagnosis (Lim et al. 2014 ).
CONCLUSIONS
Research has shown that many postpartum headaches go undiagnosed and as a result are poorly treated, often returning following discharge from secondary care (Nelson-Piercy 2010 ). The hope is that the introduction of this adjuvant will allow clinicians to identify the cause of postpartum headaches earlier and will allow life threatening diagnoses to be quickly excluded.
