Differential Diagnosis for Postpartum Headache
- 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 characteristics of the headache, which worsens with sitting up and is accompanied by nausea and vomiting. The onset of the headache a few days after the procedure also fits with PDPH.
- Other Likely diagnoses
- Migraine: Although less likely than PDPH given the context, migraine could present with severe headache, nausea, and vomiting. However, the postpartum setting and the relationship of the headache to posture are more suggestive of PDPH.
- Tension headache: This is a common type of headache but less likely given the severity and the specific characteristics (postural worsening, nausea, vomiting) described in this case.
- 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 abdominal pain makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Subarachnoid hemorrhage: Although rare, a subarachnoid hemorrhage could present with a sudden, severe headache and would be a medical emergency. The recent neuraxial anesthesia might slightly increase the risk, but this diagnosis is less likely without other signs like sudden onset, "thunderclap" headache, or focal neurological deficits.
- Venous sinus thrombosis: This is a rare but potentially life-threatening condition that can cause headache and is more common in the postpartum period. The presence of seizures, focal neurological deficits, or signs of increased intracranial pressure would increase suspicion.
- Pituitary apoplexy: This condition involves bleeding into the pituitary gland and can cause severe headache, visual disturbances, and acute hormonal deficiencies. It is rare but would be a medical emergency.
- Rare diagnoses
- Spontaneous intracranial hypotension: This condition can cause postural headaches similar to PDPH but without a clear history of dural puncture. It's less likely given the recent neuraxial anesthesia.
- Cerebral vasculitis: This is an inflammation of the blood vessels in the brain and can cause headache among other symptoms. It's rare and would typically be associated with other systemic symptoms or findings suggestive of an autoimmune process.
- Reversible cerebral vasoconstriction syndrome (RCVS): This condition can cause severe headaches and is sometimes seen postpartum. It's characterized by reversible vasoconstriction of the cerebral arteries and can be associated with thunderclap headaches and sometimes neurological deficits.