Headache and pregnancy: when the family doctor makes a difference

Abstract

Background: Headache is a common symptom encountered in primary health care. However, it may have features that suggest serious causes. The family doctor should be aware of this risk when faced with a patient with nonspecific symptom. The core competencies of family medicine should allow the doctor to manage uncertainty and to acknowledge various possibilities when faced with a pregnant patient with headache. Case description: A 21 years old patient with a history of aortic dissection at age 9 years presented to a health care center at 12 weeks of gestation complaining of daily headaches. She did not have her own family physician previously. Paracetamol was prescribed for use as needed. Due to her cardiovascular history, she was referred for obstetric consultation at a local hospital. Two weeks later she returned to the health centre without an appointment complaining of severe pulsatile headache, with phonophobia, photophobia, osmophobia, and without improvement with analgesics. The patient was referred to the local hospital emergency department, where she was examined by a neurologist, who diagnosed migraine without aura. Two weeks later, she had a follow-up consultation at the hospital for the pregnancy. She complained of severe headache again and was prescribed analgesics. One week later she returned to the health centre without an appointment (at 17 weeks gestation) because of persistence of the headache. Due to the long course without improvement and multiple consultations with different doctors, contact was made with the neurologist on call at the local hospital and an emergency consultation was arranged. A magnetic resonance angiogram revealed a left lateral sinus cerebral venous thrombosis. She was admitted to the intensive care unit and was treated with enoxaparin. Conclusion: Continuous, comprehensive care and the ability to manage health care resources gave the family physician an advantage in the management of this challenging case. This case highlights the importance of a family doctor for every patient.