Differential Diagnosis for Postpartum Headache
The patient's symptoms of a severe occipital headache that worsens with sitting, accompanied by nausea, vomiting, and neurological deficits, suggest a range of potential diagnoses. The differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Post-dural puncture headache (PDPH): This is the most likely diagnosis given the patient's recent history of neuraxial anesthesia and the characteristic symptoms of a headache that worsens with standing and improves with lying down. The presence of nausea and vomiting further supports this diagnosis.
Other Likely Diagnoses
- Migraine: Although less likely given the postpartum context and the specific characteristics of the headache, migraines can present with severe headache, nausea, and vomiting. However, they typically do not have such a clear temporal relationship to a procedure like neuraxial anesthesia.
- Tension headache: This is a common type of headache but usually does not present with the severity or the postural component described in this patient.
- Postpartum preeclampsia: The elevated blood pressure could suggest postpartum preeclampsia, which can cause headaches. However, the absence of other typical symptoms like visual disturbances or right upper quadrant pain makes this less likely.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less likely, a subarachnoid hemorrhage could present with a sudden, severe headache and should always be considered in the differential diagnosis of a severe headache, especially with neurological deficits.
- Venous thromboembolism (cerebral venous sinus thrombosis): This is a rare but potentially life-threatening condition that can cause headache and should be considered, especially in the postpartum period when the risk of thrombosis is increased.
- Spinal hematoma: A complication of neuraxial anesthesia, spinal hematoma can cause neurological deficits and should be considered, especially with the patient's history of recent neuraxial anesthesia and asymmetric strength in the lower extremities.
Rare Diagnoses
- Cerebral vasculitis: This is an inflammation of the blood vessels in the brain and is rare. It could potentially cause headache and neurological symptoms but would be an unusual diagnosis in this context.
- Pituitary apoplexy: This is a rare condition involving bleeding into the pituitary gland and can cause sudden, severe headache. It is less likely given the patient's presentation and history but should be considered in the differential diagnosis of a severe headache with neurological findings.