Differential Diagnosis for Postpartum Headache

• Single most likely diagnosis
  • Post-dural puncture headache (PDPH): This is a common complication in patients who have undergone epidural or spinal anesthesia during delivery, which can lead to a headache due to leakage of cerebrospinal fluid.
• Other Likely diagnoses
  • Migraine: Hormonal changes postpartum can trigger migraine headaches in susceptible individuals.
  • Tension headache: Stress, fatigue, and emotional changes postpartum can contribute to tension headaches.
  • Postpartum preeclampsia: Although less common, preeclampsia can occur postpartum and present with headache as a symptom.
• Do Not Miss
  • Postpartum hemorrhage with associated hypovolemic shock: Severe blood loss can lead to hypotension, which might cause a headache; early recognition is crucial.
  • Pituitary apoplexy: A rare but potentially life-threatening condition where a pituitary tumor undergoes hemorrhage or infarction, presenting with sudden, severe headache.
  • Cerebral venous sinus thrombosis: A condition more common in the postpartum period due to hypercoagulability, presenting with headache and potentially other neurological symptoms.
  • Subarachnoid hemorrhage: Although rare, it is a medical emergency that can present with a sudden, severe headache.
• Rare diagnoses
  • Spontaneous intracranial hypotension: A condition characterized by low cerebrospinal fluid pressure without an obvious cause, leading to headache.
  • Reversible cerebral vasoconstriction syndrome (RCVS): A condition that can mimic other disorders and is characterized by temporary narrowing of the blood vessels in the brain, often presenting with thunderclap headache.
  • Sheehan syndrome: Postpartum necrosis of the pituitary gland, usually resulting from severe postpartum hemorrhage, which can present with headache among other symptoms.