Postpartum Headaches with Concerning Pattern in Patient with Recent Preeclampsia History

Case at a Glance

A 30-year-old postpartum female presents with severe, time-specific headaches occurring 11 days after cesarean delivery complicated by preeclampsia and hypertension.

Patient's Story

The patient is an adult female who underwent cesarean section 11 days prior due to failed induction in the setting of mild preeclampsia and hypertension. She reports developing severe headaches for the past two consecutive evenings, with a distinct temporal pattern occurring between 6:00 PM and 11:00 PM. The headaches are described as severe and unresponsive to standard analgesics including acetaminophen and ibuprofen. Outside of these specific time periods, she remains completely asymptomatic with no headache complaints. Her current blood pressure reading is elevated at 133/94 mmHg. She expresses significant anxiety about potential hospital readmission.

Initial Assessment

Postpartum patient with history of preeclampsia presenting with severe, temporally-patterned headaches and persistent hypertension. Current medications include acetaminophen, ibuprofen, labetalol for blood pressure control, prenatal vitamins, and stool softeners.

The Diagnostic Journey

The presentation of severe headaches with a specific temporal pattern in a postpartum patient with recent preeclampsia history raises concern for several differential diagnoses including postpartum preeclampsia, cerebral edema, or other neurological complications. The elevated blood pressure reading of 133/94 mmHg, while not severely elevated, is concerning in the context of her symptom pattern and recent preeclampsia diagnosis.

Final Diagnosis

Suspected postpartum preeclampsia with severe features requiring immediate medical evaluation

Treatment Plan

Immediate medical evaluation recommended given the concerning presentation. The temporal pattern of severe headaches unresponsive to standard analgesics, combined with elevated blood pressure in a patient with recent preeclampsia, warrants urgent assessment for postpartum preeclampsia or other serious complications. Laboratory studies including complete metabolic panel, liver function tests, and urinalysis would be indicated, along with blood pressure monitoring and neurological assessment.

Outcome and Follow-up

Patient advised to seek immediate medical attention for evaluation of postpartum preeclampsia. The consulting physician emphasized that severe headaches in the postpartum period, particularly with the patient's risk factors, require prompt medical assessment despite patient's reluctance to return to the hospital.