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INTRODUCTION

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Headache is arguably the most common disorder of the nervous system, with over half of adults aged 18 to 65 years worldwide having experienced a diagnosable form of headache in any given year.1 Headaches can result from primary headache disorders such as migraine headache, tension-type headache, and cluster headache or may also be secondary results of a long list of other disorders, a few of which are specific to pregnancy. Importantly, the majority of individuals suffering from headache, be they pregnant or nonpregnant, are not correctly diagnosed by health-care providers. It is the intention of this chapter to provide guidance to obstetric care providers to facilitate the correct diagnosis and treatment of headache in pregnancy, with the dual intentions of both appropriately diagnosing and treating these frequently disabling conditions and providing guidance to these women and their family beyond the conclusion of the pregnancy.

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PRIMARY HEADACHE

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Primary headaches are migraine, tension type, and cluster headaches. Primary headaches are syndromes that are not part of other disease processes and are not associated with demonstrable organic disease or structural neurologic abnormality.

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Migraine

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Migraine headache becomes more common in women at the time of the menarche, commonly is increased around the time of menstruation, and frequently decreases in frequency and intensity with menopause. Although the diagnosis of migraine headache is often thought to require an initial aura, the majority (80%-85%) of migraine sufferers do not experience premonitory auras. The classic migraine aura is visual in nature, starts in a small portion of the visual field, and then gradually enlarges and/or moves. Auras may also involve other neurovascular symptoms such as migratory weakness or paresthesias. The distinguishing features of migraine include unilateral or bilateral, sometimes throbbing headache associated with light and sound sensitivity, nausea and/or vomiting. The majority of migraine sufferers, while not having classic auras, will frequently have characteristic (for them) symptoms in a day or 2 before the onset of the headache. These symptoms are most commonly fatigue and changes in mood or personality.

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Tension Headache

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Tension headache is the most common primary headache disorder. It is most commonly episodic but can be chronic. As with migraine, tension headache is more common in women. Tension headaches are frequently described as generalized pressure or a sensation of band-like tightness around the head that sometimes spreads into, or from, the neck. They are not associated with nausea and/or vomiting and may have light or sound sensitivity but not both.

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Cluster Headache

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Cluster headache is characterized by intermittent brief, but severe, unilateral periorbital pain associated with ipsilateral lacrimation and rhinorrhea. The eyelid may droop and there may be conjunctival injection. These headaches occur in clusters, occurring from once to several times per day for several weeks or months and then resolve for some length of time—frequently months or ...

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