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DOI: 10.1016/j.redare.2020.08.006
Available online 18 February 2021
Postpartum headache after epidural anaesthesia: Who to blame?
Cefalea postparto tras anestesia epidural: ¿a quién culpar?
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R. Diasa,
,
, C. Ferreiraa,, Â.B. Mendesa, J. Marvãoa, N. Lagesa, H. Machadoa,b
a Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
b Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Received 16 May 2020. Accepted 17 August 2020
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Table 1. Differential diagnosis of postpartum headaches.
Abstract
Introduction

Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH).

Case description

37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy.

Discussion

There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap.

Conclusion

Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.

Keywords:
Post dural puncture headache
Differential diagnosis
Pituitary apoplexy
Resumen
Introducción

La analgesia epidural está considerada la primera opción analgésica durante el parto. La cefalea post-punción lumbar (CPPL) está considerada una complicación potencial de esta técnica analgésica, siendo una hipótesis frecuente para cualquier cefalea que se produce tras el parto. Es fundamental que los anestesistas y obstetras estén familiarizados con otros posibles diagnósticos diferenciales de cefalea postparto (CPP).

Caso clínico

Mujer de 37 años que se presentó tras el parto, con cefalea pulsátil occipital intensa asociada a radiación hacia el cuello, náuseas y vómitos, hemodinámicamente estable, y con exploración física neurológica normal. Se encontraron alteraciones en los niveles de la hormona tiroidea. Los resultados de la TC fueron sugerentes de apoplejía hipofisaria.

Discusión

Existen muchos diagnósticos diferenciales para CPP, y a menudo algunos no se consideran, como en el caso de la apoplejía hipofisaria. Es fundamental diferenciar los signos y síntomas de cada diagnóstico, ya que muchos de ellos pueden solaparse.

Conclusión

No todas las cefaleas postparto son CPPL, y la primera sospecha diagnóstica puede no ser siempre la correcta.

Palabras clave:
Cefalea pospunción lumbar
Diagnóstico diferencial
Apoplejía hipofisaria

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