Headache during pregnancy: Etiologies and applicability of the ICHD-3 criteria

Abstract

IntroductionGiven the high prevalence of primary headache in the young population, and the rate of pregnancy in this age group, it is unsurprising that pregnant women present a high likelihood of consulting due to headache. ObjectivesThis study seeks to determine the main aetiologies and predictors of headache and the usefulness of the International Classification of Headache Disorders (third edition-beta; ICHD-3 beta) for differentiating primary from non-primary headaches in pregnant women at the emergency department. Patients and methodsWe performed a cross-sectional study comparing the prevalence of patients meeting the ICHD-3 beta criteria, associated symptoms, history of headache, and demographic features between primary and non-primary headaches. ResultsHeadache was responsible for 142 out of 2952 admissions (4.8%). Headache was primary, non-primary, or unclassified in 66.9%, 27.4%, and 5.6% of cases, respectively. Migraine and headache associated with hypertensive disorders were the most frequent aetiologies for primary and non-primary headaches: 91.6% and 31.4% of cases, respectively. The factors associated with primary headache were fulfilling the ICHD-3 beta criteria (OR: 23.5; 95% CI, 12.5–34.5; p<0.001), history of migraine (OR: 2.85; 95% CI, 1.18–5.94; p=0.013), history of similar episodes (OR: 6.4; 95% CI, 2.78–14.0; p<0.001), and description of phosphenes (OR: 4.2; 95% CI, 1.5–11.68; p=0.02). The factors associated with non-primary headaches were fever (OR: 12.8; 95% CI, 1.38–119; p=0.016) and mean arterial blood pressure greater than 106.6 (OR: 2.6; 95% CI, 1.7–3.5; p=0.03). ConclusionIn our study, the ICHD-3 beta criteria were useful for differentiating primary from non-primary headaches in pregnant women. History of migraine, history of similar episodes, phosphenes, fever, and high arterial blood pressure were also valuable predictors.