Get access

Predictors of Headache Before, During, and After Pregnancy: A Cohort Study

Authors

  • Dana P. Turner MSPH,

    Corresponding author
    1. From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA (D.P. Turner, J.C. Eisenach, and T.T. Houle); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman); Department of Psychiatry and Human Behavior, Head Pain Center, University of Mississippi Medical Center, Jackson, MS, USA (D.B. Penzien).
    Search for more papers by this author
  • Todd A. Smitherman PhD,

    1. From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA (D.P. Turner, J.C. Eisenach, and T.T. Houle); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman); Department of Psychiatry and Human Behavior, Head Pain Center, University of Mississippi Medical Center, Jackson, MS, USA (D.B. Penzien).
    Search for more papers by this author
  • James C. Eisenach MD,

    1. From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA (D.P. Turner, J.C. Eisenach, and T.T. Houle); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman); Department of Psychiatry and Human Behavior, Head Pain Center, University of Mississippi Medical Center, Jackson, MS, USA (D.B. Penzien).
    Search for more papers by this author
    • On behalf of the Pain After Delivery Investigators: Peter H. Pan, MD, Wake Forest School of Medicine, Winston-Salem, NC; Ruth Landau, MD, University of Washington School of Medicine, Seattle, WA; Richard M. Smiley, MD, PhD, Columbia University College of Physicians & Surgeons, New York, NY; Columbia University College of Physicians & Surgeons, New York, NY; Patricia Lavand'homme, MD, Université Catholique de Lovain, Louvain-la-Neuve, Belgium.

  • Donald B. Penzien PhD,

    1. From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA (D.P. Turner, J.C. Eisenach, and T.T. Houle); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman); Department of Psychiatry and Human Behavior, Head Pain Center, University of Mississippi Medical Center, Jackson, MS, USA (D.B. Penzien).
    Search for more papers by this author
  • Timothy T. Houle PhD

    1. From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA (D.P. Turner, J.C. Eisenach, and T.T. Houle); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman); Department of Psychiatry and Human Behavior, Head Pain Center, University of Mississippi Medical Center, Jackson, MS, USA (D.B. Penzien).
    Search for more papers by this author

  • Financial support: This analysis was funded by NIH/NINDS R01NS065257. The original PAD study was funded by NIH GM48085 and a grant from the Sceptor Foundation.

  • Conflict of Interest: Dana P. Turner: Ms. Turner receives research support from Merck. Todd A. Smitherman: Dr. Smitherman reports no conflicts of interest. James C. Eisenach: Dr. Eisenach is a consultant with Medtronics, Adnyxx, Vertex, and Glaxo-Smith-Kline and receives research support from King Pharmaceuticals. Donald B. Penzien: Dr. Penzien receives research support from Merck. Timothy T. Houle: Dr. Houle receives research support from GlaxoSmithKline and Merck and is a consultant for Allergan.

D.P. Turner, Wake Forest School of Medicine – Anesthesiology, Medical Center Boulevard, Winston-Salem, NC 27157, USA, email: daturner@wfubmc.edu

Abstract

Objective.— The present study endeavored to identify predictors of headache during pregnancy, shortly after delivery, and at 8-week follow-up.

Background.— Many women suffer from headaches during pregnancy and the post-partum period. However, little is known about factors that predict headache surrounding childbirth.

Methods.— Secondary analysis of longitudinal cohort study of 2434 parturients hospitalized for cesarean or vaginal delivery in 4 university hospitals in the United States and Europe. Data were gathered from interviews and review of medical records shortly after delivery; 972 of the women were contacted 8 weeks later to assess persistent headache. The primary outcome measures were experiencing headache during pregnancy, headache within 72 hours after delivery, and headache at 8 weeks after delivery.

Results.— Of the parturients, 10% experienced headache during pregnancy, 3.7% within 72 hours after delivery, and 3.6% at 8 weeks postdelivery. Compared to those without a history of headache, a history of headache prior to pregnancy was the strongest predictor of headache during pregnancy (9.8% vs 23.5%; risk ratio 2.4; 95% confidence interval [CI]: 1.4 to 4.0). Experiencing headache during pregnancy (adjusted hazard ratio HR 3.8; 95% CI: 2.4 to 6.2) and receiving needle-based regional anesthesia for pain treatment (adjusted hazard ratio 2.2; 95% CI: 1.1 to 4.5) were independently associated with headache within 72 hours after delivery with event rates of 11.1% and 10.5%, respectively. Compared to those without such a history, headache before pregnancy was significantly associated with experiencing headache 8 weeks after delivery (4.0% vs 23.8%; risk ratio = 6.0; 95% CI: 2.0 to 8.0), but headache during pregnancy or shortly after delivery was not. Several other psychosocial predictors (eg, somatization, smoking before pregnancy) were statistically associated with at least 1 headache outcome.

Conclusions.— A history of headache prior to pregnancy is a strong predictor of headache during and after pregnancy, the latter independent of but compounded by spinal injection. Physicians should attend to prior headache history when making decisions about pain management during and after childbirth. As the lack of formal International Classification of Headache Disorders, 2nd Edition (ICHD-II), headache diagnoses is a limitation of this study, future longitudinal studies should replicate the present design while including headache subtyping consistent with ICHD-II nosology.

(Headache 2012;52:348-362)

Ancillary