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Headache: Migraine, Pseudotumor Cerebri Syndrome, and Postnatal Headache 

Headache: Migraine, Pseudotumor Cerebri Syndrome, and Postnatal Headache
Headache: Migraine, Pseudotumor Cerebri Syndrome, and Postnatal Headache

Deborah I. Friedman

, Shamin Masrour

, and Susan Hutchinson

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date: 09 March 2021

In most cases, women with headache disorders have normal pregnancy and delivery outcomes and should not be discouraged from becoming pregnant. Pre-pregnancy planning includes weaning of contraindicated medications. Most women with migraine without aura improve during pregnancy. Although there are limitations, various acute and preventive treatments may be employed, including non-pharmacologic options. Anti-epileptic medications should be avoided. For pseudotumor cerebri, the mainstay of treatment includes diuretics and therapeutic lumbar punctures, avoiding topiramate. Surgical treatment may be necessary if vision is threatened. Close monitoring and collaboration between an ophthalmologist, neurologist and obstetrician are critical. New-onset pseudotumor cerebri requires an investigation for secondary causes such as cerebral venous thrombosis. In the absence of a pre-existing primary headache disorder, new headaches in the postnatal period warrant evaluation for secondary headache disorders, including post-dural puncture headache, stroke, cerebral venous thrombosis, pre-eclampsia, eclampsia, reversible cerebral vasoconstriction syndrome (RCVS), and pituitary apoplexy.

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