De novo migraine with aura in the third trimester of pregnancy: a case report and literature review

Background: Among all headache disorders, migraine has the highest prevalence during gestation. The majority of migraineurs experience improvement during pregnancy, but a few may experience migraine for the first time. This poses a diagnostic challenge in the differential diagnosis between primary and life-threatening secondary headache disorders. Because pregnancy itself is an independent risk factor for secondary headache disorders, it is mandatory to exclude these conditions in order to diagnose migraine. There is a large body of literature about pre-existing migraine course during pregnancy and its link with adverse pregnancy outcomes, but there are no studies examining these aspects among women with new-onset migraine during pregnancy.Case report. A 31-year-old female at 33 weeks of gestation (gravida 2, para 2) was referred to the neurologist eds disturbances, which were followed by pressing severe headache, rated as 8 out of 10 on a numeric rating scale and accompanied by dizziness. The headache lasted for one day, and dizziness continued to the following day. The patient was investigated for a secondary headache disorder, but laboratory and neuroimaging results were unremarkable. A migraine with aura was diagnosed. The patient was advised to keep a consistent sleep schedule, maintain regular low physical activity, eat regularly and take magnesium supplementation. The patient was informed about a safe treatment approach in case of an acute attack. At 40 weeks of gestation the patient delivered female newborn, weighing 3750g, with Apgar scores of 8 and 9 (due to a nuchal cord). The postpartum period was uneventful. During the subsequent 4 years, the patient did not experience any recurrent migraine attacks and had no pregnancies.Conclusion. In order to diagnose a migraine during pregnancy, exclusion of secondary headache disorders is mandatory. Pregnant migraineur should be regularly monitored for adverse birth outcomes. It is essential to educate patients, provide information about the safe treatment of migraine attacks, and explain nonpharmacological prevention and supplementation benefits.

An Unusual Case of Migraine Preconception and Severe Postpartum Headache and Intracranial Hemorrhage

Migraine affects many women in their childbearing years and gets worse during pregnancy, probably due to fluctuations in reproductive hormones. Similar changes in maternal physiology due to pregnancy increase the susceptibility toward secondary headache disorders and can cause the return of migraines in the postpartum period. Increased occurrence of headaches is also associated with the administration of epidural anesthesia, which decreases cerebrospinal fluid pressure. However, the less common causes such as secondary headache disorders related to cerebrovascular disorders and hypertension should be considered for differential diagnosis in this group of patients. In this case report, we discuss the case history of a 36-year-old woman, with a past history of migraine without aura, who presented at 1 week postpartum with headache, confusion, dizziness, right-sided weakness, and urinary incontinence. Brain imaging studies revealed global hypoxic ischemic injury to the brain. This case report discusses her presentation, investigations, management, and etiology of migraine, leading to stroke and death postpartum.

Headache

Headaches can occur independently of any other disease processes (primary headache disorders) or they can be associated with a wide variety of underlying neurologic and systemic conditions (secondary headache disorders). The pathophysiologic mechanisms are incompletely under- stood. Most research has focused on migraine headaches, with the tacit assumption that other headache syndromes, both primary and secondary, have similar mechanisms.