Treating headache is a challenge in pregnancy: safe diagnostic measures.(Obstetrics)

SCOTTSDALE, ARIZ. -- Headaches during pregnancy and the postpartum period are common, but challenges lie in considering safe diagnostic measures and the teratogenic risk of drugs when offering treatment, Dr. Christine Lay reported during a symposium that was sponsored by the American Headache Society.

Possible causes of headache during pregnancy include migraine and (less commonly) sinusitis, mass or tumor, sub-arachnoid hemorrhage, central venous thrombosis, idiopathic intracranial hypertension, and eclampsia.

If secondary headache is suspected, testing--including neuroimaging--should be considered, she advised at the meeting.

Head CT is considered to be "relatively safe" and helpful in cases of suspected subarachnoid hemorrhage or in head trauma cases, said Dr. Lay, a neurologist with the Headache Institute at St. Luke's-Roosevelt Hospital Center, New York.

Magnetic resonance imaging during pregnancy, however, may carry a potential risk and should be used only when absolutely necessary, according to Dr. Lay.

Gadolinium and CT contrast should be avoided in pregnant women, and lumbar puncture should follow imaging if raised intracranial pressure is suspected, but should not be delayed if meningitis is suspected, she said.

While migraines may either improve or worsen during pregnancy, Dr. Lay described findings from one recent study of 40O pregnant women indicating that 50% of women saw improvement by the end of their first trimester, and 90% reported either improvement or cessation of headache by the end of the third trimester.