Diagnosing causes of headache within the postpartum period
Bibliographic record
Abstract
Background: Headache is one of the most common symptoms following delivery and the underlying cause may be benign or life threatening. Identification of the cause of headache in the postpartum period can be challenging and relies on a comprehensive history and thorough examination, with particular focus on the presence or absence of neurological signs, which may suggest a more serious diagnosis (Nelson-Piercy 2010 Nelson-Piercy C. 2010. Handbook of Obstetric Medicine. 4th ed. London: Informa Healthcare [cited 2016 Dec 5]. [Crossref] , [Google Scholar]). However, through clinical experience and research, we have noted that post-partum headache is significantly under-recognised and treated (Goldszmidt et al. 2005 Goldszmidt E, Kern R, Chaput A, Macarthur A. 2005. The incidence and etiology of postpartum headaches: a prospective cohort study. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie 52:971–977. Available from: http://link.springer.com/article/10.1007/BF03022061 [cited 2016 Dec 15].[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).Aims: To ensure a standardised approach to the management of patients presenting with postpartum headache, we sought to introduce a diagnostic tool for postpartum headache.Methods: This was a literature review combined with a postpartum headache case example that occurred within our institution in 2015. Risk factors and potential clinical failures from the case were noted and compared to the literature.Results: Our case is a 28-year-old woman who developed a postpartum headache following spontaneous vaginal delivery. Of note, the patient had an epidural inserted in labour for analgesia. Initially, systemic and neurological examinations were normal and the patient was discharged home with simple analgesics and a diagnosis of tension-type headache. She represented with worsening headache, pyrexia and signs of meningism. Lumbar puncture confirmed a diagnosis of bacterial meningitis caused by Haemophilus influenzae. She was treated with IV ceftriaxone and discharged home without any long-term sequelae.In an attempt to improve recognition of post-partum headache, especially rare causes such as meningitis, NHS Tayside has chosen to adopt the PARTUM mneumonic (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).Pressure (blood pressure for pre-eclampsia/eclampsia)Anaesthetic (post-dural puncture headache)Reversible (vasoconstriction syndrome)Thrombosis (cerebral venous sinus thrombosis, ischaemic stroke)Use your brain (there are so many other causes of headache)Migraine (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).PARTUM was first devised in 2014 as part of a research paper published by the Journal Practical Neurology (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]). The aim of the mnemonic is to allow the treating physician a basic list of postpartum headache causes to use as a working diagnosis (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).Conclusions: Research has shown that many postpartum headaches go undiagnosed and as a result are poorly treated, often returning following discharge from secondary care (Nelson-Piercy 2010 Nelson-Piercy C. 2010. Handbook of Obstetric Medicine. 4th ed. London: Informa Healthcare [cited 2016 Dec 5]. [Crossref] , [Google Scholar]). The hope is that the introduction of this adjuvant will allow clinicians to identify the cause of postpartum headaches earlier and will allow life threatening diagnoses to be quickly excluded.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".