Is It Really PDPH?

The article emphasizes that postpartum headaches are not always caused by postdural puncture headache (PDPH), which is often the initial suspicion. According to a 2026 review by Bavaro and colleagues in Current Opinion in Anesthesiology, there are warning signs that indicate a neurologic emergency. These warning signs include headaches that are no longer positionally dependent, thunderclap onset, visual disturbances, elevated blood pressure, confusion, seizures or focal neurologic deficits, and persistent symptoms despite PDPH treatment. Potential diagnoses include cerebral venous sinus thrombosis (CVST), posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), intracranial hemorrhage, and pituitary disorders. Clinicians should be vigilant and consider urgent diagnostic reassessment if any of these warning signs appear.