Within this group, hypertensive disorder of pregnancy was most common, predominated by preeclampsia [47]. Various secondary headaches are more likely to occur during pregnancy, which may be related to hypercoagulability, hormonal factors, and anesthesia for labor. Pregnancy-induced hypercoagulability is an adaptive physiologic mechanism that reduces the risk of hemorrhage but increases the risk of thromboembolism; this risk extends into the postpartum period, which is defined as the first 6 weeks following delivery. Conditions related to the hypercoagulability and endothelial dysfunction include cerebral venous sinus thrombosis and RCVS. A subset of pregnancy-related RCVS is postpartum angiopathy, which is an important cause of headache in these patients and which may be underdiagnosed. Intracranial hypotension from iatrogenic CSF leak is another important consideration in postpartum patients, which may follow spinal anesthesia or inadvertent dural puncture during epidural anesthesia (also refer to Variant 5) [12,49]. The incidence of primary malignant tumors in pregnant women is slightly lower than in nonpregnant women; however, studies have shown that both tumor volume and growth increase during pregnancy, especially with respect to gliomas. Lesions such as meningiomas express progesterone receptors and are known to regress after pregnancy. These gestational tumoral changes also correlated with clinical worsening and increased frequency of seizure that may precipitate obstetrical emergencies [50]. Breast cancer and choriocarcinoma are 2 of the most common types of cancers that can metastasize to the brain in pregnancy [49]. Pituitary disorders are also a cause of symptoms during pregnancy. The adenohypophysis increases in volume by 30% in pregnancy. Prolactinomas are the most common pituitary tumors occurring during pregnancy, and a small percentage of microadenomas show signs of tumor enlargement.
Headache PCAs. Within this group, hypertensive disorder of pregnancy was most common, predominated by preeclampsia [47]. Various secondary headaches are more likely to occur during pregnancy, which may be related to hypercoagulability, hormonal factors, and anesthesia for labor. Pregnancy-induced hypercoagulability is an adaptive physiologic mechanism that reduces the risk of hemorrhage but increases the risk of thromboembolism; this risk extends into the postpartum period, which is defined as the first 6 weeks following delivery. Conditions related to the hypercoagulability and endothelial dysfunction include cerebral venous sinus thrombosis and RCVS. A subset of pregnancy-related RCVS is postpartum angiopathy, which is an important cause of headache in these patients and which may be underdiagnosed. Intracranial hypotension from iatrogenic CSF leak is another important consideration in postpartum patients, which may follow spinal anesthesia or inadvertent dural puncture during epidural anesthesia (also refer to Variant 5) [12,49]. The incidence of primary malignant tumors in pregnant women is slightly lower than in nonpregnant women; however, studies have shown that both tumor volume and growth increase during pregnancy, especially with respect to gliomas. Lesions such as meningiomas express progesterone receptors and are known to regress after pregnancy. These gestational tumoral changes also correlated with clinical worsening and increased frequency of seizure that may precipitate obstetrical emergencies [50]. Breast cancer and choriocarcinoma are 2 of the most common types of cancers that can metastasize to the brain in pregnancy [49]. Pituitary disorders are also a cause of symptoms during pregnancy. The adenohypophysis increases in volume by 30% in pregnancy. Prolactinomas are the most common pituitary tumors occurring during pregnancy, and a small percentage of microadenomas show signs of tumor enlargement.