Clinical Reasoning: A 36-Year-Old Woman Presenting With Headache Postpartum

A 36-year-old healthy G2P2 woman presented on postpartum day 10 with severe headache, progressing over several hours. She had no history of migraines and used neither medications nor drugs. The headache was not postural. She reported no associated neurologic symptoms or trauma. She described chest pain radiating to the thoracic spine, without visual changes, abdominal pain, or lower limb edema. Blood pressure (BP) was 166/94 mm Hg. She was afebrile. Mental status was normal. Examination revealed mild neck stiffness, without papilledema or focal neurologic deficits. Deep tendon reflexes were symmetrically brisk. Investigations showed no anemia, thrombocytopenia, liver dysfunction, or proteinuria. ECG and thoracic CT angiogram (CTA) were normal.

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