Differential Diagnosis for Postpartum Female with Severe Occipital Headache

Single Most Likely Diagnosis

• Postpartum Preeclampsia: This condition is characterized by the onset of high blood pressure (hypertension) during the postpartum period, often accompanied by symptoms such as headache. The patient's presentation with severe occipital headache and significantly elevated blood pressure (200/100 mmHg) 1 week postpartum, without focal deficits or abnormalities on CT brain scan, aligns closely with postpartum preeclampsia.

Other Likely Diagnoses

• Postpartum Migraine: Migraines can be severe and are known to occur postpartum. The severe occipital headache could be indicative of a migraine, especially if the patient has a history of migraines.
• Post-Dural Puncture Headache (PDPH): If the patient had a spinal or epidural anesthesia during delivery, she could be experiencing a PDPH, which typically presents as a severe headache that worsens with standing and improves with lying down.
• Tension-Type Headache: Although less likely given the severity and the postpartum context, tension-type headaches can occur and might be considered if other more serious conditions are ruled out.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: Although the CT brain was negative, it's crucial not to miss this potentially life-threatening condition. A lumbar puncture might be necessary if there's a high index of suspicion, despite a negative CT.
• Cerebral Venous Thrombosis (CVT): CVT can present with headache and is a significant concern in the postpartum period due to the hypercoagulable state. A negative CT does not rule out CVT, and further imaging (e.g., MRI or CT venography) might be needed.
• Reversible Cerebral Vasoconstriction Syndrome (RCVS): This condition can cause severe headaches and is often associated with postpartum status or the use of certain medications. It's crucial to consider RCVS, especially if the patient's condition does not improve with treatment for other suspected causes.

Rare Diagnoses

• Pituitary Apoplexy: A rare condition involving hemorrhage or infarction of the pituitary gland, which can present with sudden, severe headache. Although rare, it's a critical diagnosis to consider due to its potential impact on the patient's health.
• Spontaneous Intracranial Hypotension: This condition, characterized by low cerebrospinal fluid pressure, can cause severe headaches and might be considered if other diagnoses are ruled out and there are suggestive symptoms or signs.

Management Plan

1. Immediate Blood Pressure Control: Given the patient's significantly elevated blood pressure, immediate management with antihypertensive medications is crucial to prevent complications such as stroke.
2. Further Diagnostic Evaluation: Based on the differential diagnoses, further tests such as lumbar puncture, MRI, or CT venography might be necessary to rule out conditions like subarachnoid hemorrhage, cerebral venous thrombosis, or reversible cerebral vasoconstriction syndrome.
3. Headache Management: Treatment for the headache itself, which might include pain management medications, should be initiated. The choice of medication will depend on the suspected underlying cause of the headache.
4. Monitoring: Close monitoring of the patient's blood pressure, neurological status, and overall condition is essential. This might involve admission to a hospital for observation and management.
5. Consultation: Depending on the patient's condition and the suspected diagnoses, consultation with specialists such as neurologists or obstetricians with expertise in high-risk pregnancies might be beneficial.