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Согласно Авторы-невропатологи сообщили о том, что основными причинами вторичной головной боли были гипертензивные нарушения (51%), преобладавшие над преэклампсией (33,8%) и одна треть головных болей среди беременных женщин указывает на более серьезные проблемы со здоровьем, например, гипертензию или преэклампсию.
According to a small, one-center, retrospective study of clinical data, one-third of headaches among pregnant women indicate more serious health problems, such as hypertension or preeclampsia.
Physician Matthew N. Robbins, director of the in-patient department of the Montefiore Headache Center, head of the neurological service at Jack D. Weiler Hospital (Montefiore) and associate professor of clinical neurology at the College of Medicine Albert Einstein (New York City), found that 35% of pregnant women had acute headache women was a symptom of a more serious medical problem (secondary headache). Neuropathological authors reported that the main causes of secondary headache were hypertensive disorders (51%) that prevailed over preeclampsia (33.8%).
When comparing the symptoms of primary and secondary headaches, some key differences were identified (in cases where headache was the only symptom). As expected, secondary headaches were associated with high blood pressure (55.1% compared with 8.8%, P <0.0001), pathological neurological status (34.7% compared with 16.5%, P = 0.0014), convulsive seizures (12.2% compared with 0.0%, P = 0.0015), as well as a history of headaches (36.7% compared with 13.2%, P = 0 , 0012) when compared with primary headaches.
Doctor Robert Atlas, a researcher at the American College of Obstetrics and Gynecology, head of the obstetric and gynecological services of the Mersey Medical Center (Baltimore), said that many patients with headaches receive help from an obstetrician-gynecologist, but in the most disturbing cases they are sent for a consultation with a neurologist . He also sent an email to MedPage Today , indicating that cases where an obstetrician-gynecologist seeks advice from a neurologist about a patient suffering from a serious illness are a matter of serious concern.
The most common diagnosis was migraine, accounting for 59.3% of all diagnoses and the vast majority (91.2%) among primary headaches. The most common neurological symptom was visual impairment (56.4%). Of the 118 patients (87.9%) who underwent neuroimaging, 55.9% showed normal results, while 26.3% reported random deviations, and 17.8% showed pathological changes leading to a diagnosis of secondary headache pain.
According to physician Timothy Collins, assistant professor of neurology, head of the headache department at Duke University School of Medicine, the strength of the study was a detailed examination of patients by a neurologist. He also told MedPage Today that a thorough examination, including MRI imaging, should be performed in all pregnant women with a first-time headache or an unexpected change in their nature and any signs of secondary headache (arterial hypertension, seizure, fever and pathological neurological status) .
The association of secondary headaches with high blood pressure significantly increased (OR 17.0, 95% CI from 4.2 to 56.0) in multivariate regression models, but they also had a 5 times higher tendency to be associated with the absence of headache in history (OS 4.9, CI from 1.7 to 14.5). Patients with a history of headache and secondary headache were predisposed to a longer duration of seizures, which distinguished their seizures from the previous headache (61.3% compared to 38.0%, P = 0.0027) when compared with the primary headache ,
Primary headache was found in most pregnant patients (65%). The primary headache in patients was associated with a psychiatric diagnosis (24.2% compared with 4.1, P = 0.0020), a history of headache (83.3% compared with 63.3 P = 0.0012) and photophobia (59.3% compared with 34.7%, P = 0.005) when compared with secondary headache.
Робинс сообщил MedPage Today, что клиническая практика дала очень многое для этого исследования. Его и его коллег часто вызывают в отделения/больницы скорой медицинской помощи для осмотра беременных женщин с сильной головной болью, но в литературе было очень мало указаний, связанных с распределением пациентов и диагностикой. Он считает, что это исследование впервые перечисляет связь различных факторов риска вторичной головной боли у беременных женщин и дает практикующему невропатологу и акушеру выборку диагнозов, которые могут ожидаться у пациенток с сильной головной болью в будущем.
Этот ретроспективный анализ медицинских карт был проведен с использованием данных с июля 2009 года по июль 2014 года. В исследовании были использованы данные о 140 женщинах, наблюдавшихся в отделении неотложной помощи, приемном отделении роддома или предродовых отделениях городского медицинского центра. Демографически, средний возраст женщин составлял 29,4 года (+/- 6,4 года), они были преимущественно афроамериканками (39,3%) или латиноамериканками (36,4%). 56,4% из них были в третьем триместре беременности, у 78,6% была головная боль в анамнезе. Ретроспективный дизайн и демографические характеристики с высоким процентом афроамериканок и латиноамериканок значительно влияют на частоту встречаемости преэклампсии, что было основным ограничением исследования.
Atlas added that the study did not take into account the total number of patients with headaches who did not require a neurological consultation from an obstetrician-gynecologist, so the actual number of patients with headaches during pregnancy is much higher.
Robbins would prefer to see data confirmed in other populations, including the general obstetric population, rather than the population present in a particular hospital. He believes that something is known about migraine and the adverse effects of pregnancy during childbirth, but little is known about those who suffer from severe headaches during pregnancy, as well as the effects of headaches on pregnancy outcomes, such as the incidence of preeclampsia, premature childbirth, low birth weight, cesarean section.
MedPage Today
Headaches in Pregnancy May Signal Serious Illness
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