Low-pressure headache presenting in early pregnancy with dramatic response to glucocorticoids: a case report

INTRODUCTION: Obstetricians are familiar with postural headaches in their postpartum patients following spinal or epidural anaesthesia. The rare occurrence in the antepartum patient without inciting event, may pose a diagnostic and treatment dilemma with resultant prolongation of disabling headaches in affected patients. Awareness of this condition, if accurately diagnosed, may allow for earlier relief from disabling headache, which may take weeks to months to otherwise resolve. CASE PRESENTATION: A case of low-pressure or postural headache (spontaneous intracranial hypotension) in a 39-year-old Caucasian patient in early pregnancy follows. She was initially misdiagnosed with migraine headache, but subsequently thought to have low-pressure headache. CONCLUSIONS: Obstetricians/neurologists need to be aware of the potential treatment options for pregnant patients. Due to the desire to limit caffeine (a standard treatment for low-pressure headache) in pregnancy, high-dose glucocorticoids may provide rapid relief without significant risk to the immunocompetent patient or the pregnancy. Our case offers a non-interventional approach in the pregnant patient with resultant quick response to treatment without significant adverse fetal risk.