Table 2.

Clinical features of secondary headache disorders in pregnancy [11,13–17]

	Headache disorder	Character	Aggravating factors	Other symptoms/signs	Relevant history	Diagnostic method
Cerebrovascular Disorders	Ischaemic stroke	Ipsilateral or bilateral, variable in quality, moderate	-	FNS, impaired consciousness	Preeclampsia/eclampsia, hyperemesis, multiparity, caesarean delivery, migraine, underlying prothrombotic condition	Non-contrast-enhanced CT scan
	Cerebral venous thrombosis	Diffuse, can be unilateral, sudden (even thunderclap) or subacute, progressive, mild to severe	-	FNS, nausea, papilledema, altered mental status, pulsatile tinnitus	Traumatic delivery or caesarean section, postdural puncture CSF leak, migraine, underlying prothrombotic condition, obesity, prolonged bed rest, dehydration, anaemia	MR angiography
	Reversible cerebral vasoconstriction syndrome	Diffuse, thunderclap, throbbing, severe, recurring over 1–2 weeks	Straining, exertion	Fluctuating FNS, hypertension	Preeclampsia, postpartum state, hypertensive encephalopathy, use of vasoactive medications/drugs	Conventional cerebral angiography (segments of arterial constriction and dilatation)
Pituitary apoplexy	Pituitary apoplexy	Retro-orbital, sudden or thunderclap, severe	-	Diplopia, visual field deficits, or decreased visual acuity, vomiting, impaired consciousness, hypopituitarism	Pre-existing pituitary adenoma	MRI
Space-occupying lesions	Intracranial neoplasm	Diffuse (can be ipsilateral), progressive, mild to severe	Valsalva-like manoeuvres, horizontal position, worsening of neoplasm	FNS, visual changes, nausea/vomiting	Pre-existing pituitary adenoma, meningioma, primary glial brain tumor, colloid cysts or Chiari malformations	MRI
Pressure-related disorders	Idiopathic intracranial hypertension	Diffuse and/or constant (non-pulsating), daily	Coughing, straining	Visual field defect, pulsatile tinnitus, 6th nerve palsy, papilledema	Obesity, rapid weight gain	Lumbar puncture: opening pressure >250 mmHg
Hypertensive disorders	Preeclamptic	Diffuse, acute, pulsating	Physical activity, rising blood pressure	Visual changes, epigastric pain, nausea/vomiting, low amount of urine, liver problems, thrombocytopenia, intrauterine growth restriction	>20 weeks of gestation, migraine	Protein/creatinine ratio > 0.3 and SBP ≥140 or DPB ≥ 90 mmHg on two occasions at least 4 hours apart

FNS – focal neurological signs (neurological deficits or seizures), SBP/DPB – systolic/diastolic blood pressure, CT – computer tomography, MRI – magnetic resonance imaging, CSF – cerebrospinal fluid.