Skip to main content

Brain imaging in pregnant women with acute headache

Journal of Neurology volume 265, pages 1836–1843 (2018)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Maggioni F, Alessi C, Maggino T, Zanchin G (1997) Headache during pregnancy. Cephalalgia 17:765–769

    Article  PubMed  CAS  Google Scholar 

  2. Robbins MS, Farmakidis C, Dayal AK et al (2015) Acute headache diagnosis in pregnant women. Neurology 85:1024–1030

    Article  PubMed  PubMed Central  Google Scholar 

  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):114

    Article  Google Scholar 

  4. Ramchandren S, Cross BJ, Liebeskind DS (2007) Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging. Am J Neuroradiol 28:1085–1087

    Article  PubMed  CAS  Google Scholar 

  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 251:517–524

    Article  PubMed  Google Scholar 

  6. Kanekar S, Bennett S (2016) Imaging of neurologic conditions in pregnant patients. RadioGraphics 36:2102–2122

    Article  PubMed  Google Scholar 

  7. Barton JR, Sibai BM (1991) Cerebral pathology in eclampsia. Clin Perinatol 18:891–910

    Article  PubMed  CAS  Google Scholar 

  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):935–943

    Article  PubMed  CAS  Google Scholar 

  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 189:904–912

    Article  Google Scholar 

  10. Edlow JA, Caplan LR, O’Brien K et al (2013) Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 12:175–185

    Article  PubMed  Google Scholar 

  11. Semere LG, McElrath TF, Klein AM (2013) Neuroimaging in pregnancy: a review of clinical indications and obstetric outcomes. J Matern Neonatal Med 26:1371–1379

    Article  Google Scholar 

  12. Ray JG, Vermeulen MJ, Bharatha A et al (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316(9):952–961

    Article  PubMed  Google Scholar 

  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):582–589

    Article  PubMed  CAS  Google Scholar 

  14. Ravishankar K (2016) Which headache to investigate, when, and how? Headache 56(10):1685–1697

    Article  PubMed  CAS  Google Scholar 

  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 2008:23–37

    Google Scholar 

  16. Kanal E, Barkovich AJ, Bell C et al (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:501–530

    Article  PubMed  Google Scholar 

  17. Klein JP, Hsu L (2011) Neuroimaging during pregnancy. Semin Neurol 31:361–373

    Article  PubMed  Google Scholar 

  18. Chansakul T, Young GS (2017) Neuroimaging in pregnant women. Semin Neurol 37(6):712–723

    Article  PubMed  Google Scholar 

  19. Skliut M, Jamieson DG (2016) Imaging of headache in pregnancy. Curr Pain Headache Rep 20(10):56

    Article  PubMed  Google Scholar 

  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):933–940

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Expert Panel on Neurologic Imaging (2017) ACR appropriateness criteria® sinonasal disease. J Am Coll Radiol 14:S550–S559

    Google Scholar 

  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.

    Article  Google Scholar 

  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:c5204

    Article  PubMed  PubMed Central  Google Scholar 

  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):791–793

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Land Berlin. Statistischer Bericht 2015. Einwohnerinnen und Einwohner im Land Berlin am 30. 2015. https://www.statistik-berlin-brandenburg.de/publikationen/stat_berichte/2016/ SB_A01-05-00_2015h01_BE.pdf. Accessed 30 Jan 2018

Download references

Funding

None.

Author information

Author notes

  1. Bianca Raffaelli and Lars Neeb contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Bianca Raffaelli, Lars Neeb, Heike Israel-Willner, Jeannette Körner, Thomas Liman & Uwe Reuter

  2. Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Eberhard Siebert

Authors
  1. Bianca Raffaelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Neeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heike Israel-Willner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeannette Körner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Liman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uwe Reuter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eberhard Siebert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Neeb.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Raffaelli, B., Neeb, L., Israel-Willner, H. et al. Brain imaging in pregnant women with acute headache. J Neurol 265, 1836–1843 (2018). https://doi.org/10.1007/s00415-018-8924-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8924-6

Keywords

  • Headache
  • Pregnancy
  • Secondary headache
  • Brain imaging
  • Red flags