postpartum headache from hell

[Jadefeather7]

Wondering if anyone here has suffered with a severe post partum headache (the type that makes you think you are about to die).

I had one during my c section. My blood pressure was so erratic (it was low throughout the pregnancy) that the anaesthetist told my husband that he was convinced his machine must be broken (I’m now doubtful about that). Two days later I had one again. All I remember is screaming at my husband to make sure he looked after my baby because this was it. I ended up in A&E and the doctors were baffled. I had MRIs after and everything was fine.

I’m pregnant again and I’m still traumatised by this experience. I’m reading stuff online about RCVS (I’m guessing that’s what I had) and potential risks of stroke and haemorrhage. I’m not really sure what to do as the doctors/consultants I’ve seen have all seemed pretty clueless about it. I can’t even find accounts online of people who have experienced it to see if it recurred for them. What would you do?

@legalseagull Did yours get better if you were lying down? Did they consider it to be the classic ‘epidural headache’? If no to both then it’s possible you had the same type - RCVS.

@legalseagull just realised yours happened during the c section. That’s like my first one which was during the surgery. I remember asking my husband to press on my head really hard as the pressure was building up and was so intense

Sorry one other thing @legalseagull was your other c section after the one with the headache or before?

My first c section I had an epidural and didn't get the headache. The second c section was a spinal. I was still laying down and being stitched up when the headache hit. It had taken five attempts to get the spinal in place so I'm guessing that had something to do with it. The headache lasted all which I was in recovery, so still laying down. The midwives were injecting various pain killers to get rid of it.

I've never heard of RCVS. I hadn't thought about this being a 'thing'. Just thought I had a bad reaction or something. Interesting

Interesting, my epidural administration wasn’t straightforward either. I think I it took 2-3 attempts

The surgeons and midwives all told me it was caused by the spinal so I don't think RCVS (having just done a quick google). I think it was just bad luck and not certain to happen again.

My first c section got the epidural in straight away. The second - For days after I had intense pain in my back. I think them taking five attempts really caused a lot of problems, thankfully none lasting. I was contracting constantly and fully dialated at the time, so granted, it was a stressful administration, but god she was shit. They had to call someone else down who got it first time

My friend had this post epidural and had to have a spinal plaster. Apparently the epidural left a small hole

She had MRI and all sorts she was convinced she had a tumour it was awful.

She researched herself and insisted on a scan for the hole and she was right.

High blood pressure (and associated headaches) can happen as part of post delivery eclampsia after a natural birth too. Make sure your medical team is aware of your previous history - drugs can be used to bring down blood pressure if needed. (This happened to me with DS1 but not DS2 so no guarantee it will happen again).

My first thought was eclampsia and I see others have suggested it. I had pre eclampsia, and the headache I had in the hours before delivery and during my c section was like nothing I have ever experienced before - and I get severe migraines so I'm no stranger to horrendous head pain. It was so much worse whenever I lay down which made it different to anything I'd had before.

I'd make sure you're well monitored and that your BP is carefully observed this time. Hope all goes well for you.

Did they give you a blood test? If there was eclampsia it would show up in bloods even if you BP had returned to normal range.

@mulberrypeony I think I had one after the c section (Isnt it routine?). They said my iron was slightly on the low side (I think that was because of blood test and not because of amount of blood loss). I need my notes. It’s all hazy

I would certainly make the surgical team aware at your pre assessment OP, I believe what you are referring to specifically is called Postpartum Cerebral Angiopathy. It is uncommon though and would be somewhat unusual that there was no evidence of it in blood markers or your cerebral imaging (depending on the what was done). You would need a high resolution CT or MRI, normal CT can prohibit a diagnosis; they offer a low diagnostic yield for subtle changes in white and don't allow assessment of the intracranial vasculature (which is where the problem originates). I would request to speak with a neurologist and your surgical team to work towards forming a plan that avoids certain vasosuppressor drugs which are often used during c section/surgery (it is used to avoid hypotension during the procedure and is a likely trigger alongside PE) and also ensure the correct equipment and access to radiology/angiography is in hand at your hospital.

I have a vasovagal condition and really recommend buying a cheap BP monitor for when you're at home. They're pretty reliable and can put your mind at rest as to whether it might be time to seek further medical attention. Better safe than sorry.

Yes! Me! I didn't have an epidural but 2 weeks after giving birth I woke up feeling like I'd been hit in the back of the head by a baseball bat. I genuinely thought I was dying or having a stroke. We called an ambulance and had loads of tests and a night in the hospital. Nothing found and the consultant said it was an 'extreme migraine'. It eased off slowly but took 2 days to completely go away. Never experienced anything like it again. It was utterly terrifying.

@dontgobaconmyheart Amazing! Is it because of your condition that you know about this or are you a medical professional?

The doctors I saw after going to A&E said they would only do an MRI if I had a third recurrence which never happened. I had an MRI privately after a month because I continued to have much more mild headaches but nothing was found. I didn’t have any blood test done at that point.

I will definitely ask my midwife to refer me to a neurologist so I can discuss the impact of the drugs.

Super helpful. Thank you so much.

Your mentioning that you had a vasovagal condition reminded me that I fainted several times during pregnancy but was told it’s pretty common.

Was your blood pressure high or low during the cesarean?

Epidural headache risk info

www.rcoa.ac.uk/sites/default/files/documents/2019-09/10-HeadachesSpinalEpidural2015web.pdf

@Blahblahblahnanana It went both very high and very low according to my husband. All I remember the anaesthetist saying is that the readings are all over the place, they can’t be right, the machine must be broken.

Mine didn’t get better when lying flat. It started when lying flat that’s why epidural headache was ruled out.

I presume you had an emergency section the first time if it was under epidural? It was more than likely a post Dural headache where you get a small tear from the epidural needle that means spinal fluid leaks. Especially if it took a few tries.

If you have another section it will be elective and so you will have a spinal instead which has a much lower risk of this happening (it’s a much smaller needle as they don’t leave the tube in for top ups like with epidurals.

Blood pressure during a section can be erratic. You had an awful anaesthetist. Epidural/spinals lower blood pressure so you are usually given an infusion of a medication to bring it up. This can go up and down though and needs adjustment which is why your blood pressure is taken every 5 minutes. Some other drugs given also affect your blood pressure (that contract your uterus as it’s not a natural process in a section).

I am a theatre practitioner so assist the anaesthetist with anaesthetics in theatres.

@DaveMinion I actually had an elective. I just remembered that it was either a spinal or combined spinal epidural. Gosh my memory of the whole thing is pretty bad!

I think my blood pressure did go crazy high during the section. I’ve been looking at some studies online and the vasosupressors like ephedrine that are used to raise blood pressure can cause a sudden jump in blood pressure. I wish one of the many doctors I met had explained this to me. Instead it took someone on mumsnet (dontgobaconmyheart) to alert me to this! The alternatives to ephedrine (if that was what was used) don’t seem great either but maybe they can adjust the dosage.

‘Many studies have documented tendency of blood pressure to overshoot following the use of ephedrine.’
www.ncbi.nlm.nih.gov/pmc/articles/PMC3696275/

@Jadefeather7 you need to ask the hospital (through PALS) for a debrief about what happened during and after the cesarean, so you can then have an informed discussion about your plan of care as you’ll be under obstetric consultant led care if you’re pregnant again.

No one on a forum can give you the right advice especially without a detailed history of events.

@Blahblahblahnanana Actually someone on this forum has given me more insight into what likely happened then any of the doctors I saw. I saw a number of different doctors after it happened and they were all baffled and unable to offer me any sort of explanation. All they could tell me was that it didn’t seem like a classic spinal/epidural headache I will obviously be speaking to doctors now but I feel much more confident doing that armed with some knowledge about this. After dontgobaconmyhearts post I’ve discovered some research papers which mention that in some patients Vasopressors can cause reactive hypertension which can lead to thunderclap headaches.