10.3.4 Headache attributed to pre-eclampsia or eclampsia

Description:
Headache, usually bilateral and pulsating, occurring in women during pregnancy or the immediate puerperium with pre-eclampsia or eclampsia. It remits after resolution of the pre-eclampsia or eclampsia.

Diagnostic criteria:
A. Headache, in a woman who is pregnant or in the puerperium (up to 4 weeks postpartum), fulfilling criterion C
B. Pre-eclampsia or eclampsia has been diagnosed
C. Evidence of causation demonstrated by at least two of the following:

    1. headache has developed in temporal relation to the onset of the pre-eclampsia or eclampsia
    2. either or both of the following:

      a) headache has significantly worsened in parallel with worsening of the pre-eclampsia or eclampsia
      b) headache has significantly improved or resolved in parallel with improvement in or resolution of the pre-eclampsia or eclampsia

    3. headache has at least two of the following three characteristics:

      a) bilateral location
      b) pulsating quality
      c) aggravated by physical activity

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
Pre-eclampsia and eclampsia appear to involve a strong maternal inflammatory response, with broad immunological systemic activity. A placenta appears essential for their development, although case reports indicate that eclampsia can occur in the puerperium as well as during pregnancy.

Pre-eclampsia and eclampsia are multi-system disorders with various forms. Their diagnosis requires hypertension (>140/90 mm Hg) documented on two blood pressure readings at least four hours apart, or a rise in diastolic pressure of ≥15 mm Hg or in systolic pressure of ≥30 mm Hg, coupled with urinary protein excretion >0.3 g/24 hours. In addition, tissue oedema, thrombocytopaenia and abnormalities in liver function can occur.