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New-onset severe headache in late pregnancy is concerning for several potentially catastrophic neurologic conditions including cerebral vein thrombosis, cerebral haemorrhage and reversible cerebral vasoconstriction syndrome. There is always a question of the use of brain MRI in the pregnant patient with new-onset headache, especially in women with normal neurologic examinations. A case of new-onset pregnancy-related headache is presented in which the aetiology was diagnosed solely from findings on neuroimaging.
Case: A 36-week pregnant, 31-year-old woman, presented with a 5-day history of severe right-sided headaches. She had a long history of episodic migraine, but this current headache was much different from her previous head pains. The headache was frontotemporal in location, persistent at a low level intensity but would spike 5× per day to 10/10 in intensity for 20 min in duration but without migrainous or cranial autonomic symptoms. The pain did not exacerbate with any head position or head movement. …