Journal of Neurology

, Volume 265, Issue 8, pp 1836–1843 | Cite as

Brain imaging in pregnant women with acute headache

  • Bianca Raffaelli
  • Lars Neeb
  • Heike Israel-Willner
  • Jeannette Körner
  • Thomas Liman
  • Uwe Reuter
  • Eberhard Siebert
Original Communication



Brain imaging is one of the most important diagnostic methods for evaluating headache during pregnancy. In this study, we aimed to identify anamnestic and clinical predictors for pathological brain imaging findings in pregnant women suffering from acute headache.


We conducted a retrospective chart review of 151 pregnant women with acute headache between 2010 and 2016. We screened the medical records of these patients and analyzed radiological variables, including brain imaging frequency and modality, delay to imaging and imaging findings. In patients with brain imaging, we compared several anamnestic and clinical features between those with and without symptomatic pathological findings.


Half of the patients (50.3%) underwent brain imaging, mainly magnetic resonance imaging (MRI) including venography (53.9%) or MRI including both venography and arteriography (31.6%). Symptomatic pathological results could be observed in 27.6% of the patients with a brain scan. Patients in the first trimester with acute headache had a statistically higher risk for a symptomatic pathological imaging finding (p = 0.024). Strong pain intensity, a reduced level of consciousness and seizures were significantly associated with a symptomatic pathological imaging outcome across all stages of pregnancy.


Brain imaging may reveal a secondary headache etiology in more than 25% of pregnant women presenting with acute headache. In particular, when the acute headache is of severe intensity, and the headache is accompanied by seizures or a change in consciousness, brain imaging is required.


Headache Pregnancy Secondary headache Brain imaging Red flags 




Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

Informed consent from patients as well as approval from the ethical review committee were not required due to the retrospective review of medical records.


  1. 1.
    Maggioni F, Alessi C, Maggino T, Zanchin G (1997) Headache during pregnancy. Cephalalgia 17:765–769CrossRefPubMedGoogle Scholar
  2. 2.
    Robbins MS, Farmakidis C, Dayal AK et al (2015) Acute headache diagnosis in pregnant women. Neurology 85:1024–1030CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Raffaelli B, Siebert E, Körner J et al (2017) Characteristics and diagnoses of acute headache in pregnant women—a retrospective cross-sectional study. J Headache Pain 4;18(1):114CrossRefGoogle Scholar
  4. 4.
    Ramchandren S, Cross BJ, Liebeskind DS (2007) Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging. Am J Neuroradiol 28:1085–1087CrossRefPubMedGoogle Scholar
  5. 5.
    Lazarus E, Debenedectis C, North D et al (2009) Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients—1997–2006. Radiology 251:517–524CrossRefPubMedGoogle Scholar
  6. 6.
    Kanekar S, Bennett S (2016) Imaging of neurologic conditions in pregnant patients. RadioGraphics 36:2102–2122CrossRefPubMedGoogle Scholar
  7. 7.
    Barton JR, Sibai BM (1991) Cerebral pathology in eclampsia. Clin Perinatol 18:891–910CrossRefPubMedGoogle Scholar
  8. 8.
    Liman TG, Bohner G, Heuschmann PU et al (2012) Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases. Eur J Neurol 19(7):935–943CrossRefPubMedGoogle Scholar
  9. 9.
    McKinney AM, Short J, Truwit CL et al (2007) Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. Am J Roentgenol 189:904–912CrossRefGoogle Scholar
  10. 10.
    Edlow JA, Caplan LR, O’Brien K et al (2013) Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 12:175–185CrossRefPubMedGoogle Scholar
  11. 11.
    Semere LG, McElrath TF, Klein AM (2013) Neuroimaging in pregnancy: a review of clinical indications and obstetric outcomes. J Matern Neonatal Med 26:1371–1379CrossRefGoogle Scholar
  12. 12.
    Ray JG, Vermeulen MJ, Bharatha A et al (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316(9):952–961CrossRefPubMedGoogle Scholar
  13. 13.
    Dentali F, Squizzato A, Marchesi C et al (2012) D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost 10(4):582–589CrossRefPubMedGoogle Scholar
  14. 14.
    Ravishankar K (2016) Which headache to investigate, when, and how? Headache 56(10):1685–1697CrossRefPubMedGoogle Scholar
  15. 15.
    ACR guidelines and technical standards (2008) ACR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. Am Coll Radiol 2008:23–37Google Scholar
  16. 16.
    Kanal E, Barkovich AJ, Bell C et al (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:501–530CrossRefPubMedGoogle Scholar
  17. 17.
    Klein JP, Hsu L (2011) Neuroimaging during pregnancy. Semin Neurol 31:361–373CrossRefPubMedGoogle Scholar
  18. 18.
    Chansakul T, Young GS (2017) Neuroimaging in pregnant women. Semin Neurol 37(6):712–723CrossRefPubMedGoogle Scholar
  19. 19.
    Skliut M, Jamieson DG (2016) Imaging of headache in pregnancy. Curr Pain Headache Rep 20(10):56CrossRefPubMedGoogle Scholar
  20. 20.
    Cantu J, Clifton RG, Roberts JM et al (2014) Laboratory abnormalities in pregnancy-associated hypertension: frequency ans association with pregnancy outcomes. Obstet Gynecol 124(5):933–940CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Expert Panel on Neurologic Imaging (2017) ACR appropriateness criteria® sinonasal disease. J Am Coll Radiol 14:S550–S559Google Scholar
  22. 22.
    Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808.CrossRefGoogle Scholar
  23. 23.
    Perry JJ, Stiell IG, Sivilotti ML et al (2010) High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ 341:c5204CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Linn FH, Rinkel GJ, Algra A, van Gijn J (1998) Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry 65(5):791–793CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Land Berlin. Statistischer Bericht 2015. Einwohnerinnen und Einwohner im Land Berlin am 30. 2015. SB_A01-05-00_2015h01_BE.pdf. Accessed 30 Jan 2018

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Bianca Raffaelli
    • 1
  • Lars Neeb
    • 1
  • Heike Israel-Willner
    • 1
  • Jeannette Körner
    • 1
  • Thomas Liman
    • 1
  • Uwe Reuter
    • 1
  • Eberhard Siebert
    • 2
  1. 1.Department of NeurologyCharité Universitätsmedizin BerlinBerlinGermany
  2. 2.Institute of NeuroradiologyCharité Universitätsmedizin BerlinBerlinGermany

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