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A new headache during late pregnancy: consider the nasal mucosa as a ‘point’ of reference
  1. Todd D Rozen
  1. Correspondence to Dr Todd D Rozen, Geisinger Health System, Department of Neurology, Geisinger Specialty Clinic, MC 37-32, 1000 East Mountain Blvd Wilkes-Barre, PA 18711, USA; tdrozmigraine{at}

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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. …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.