Postpartum Headache and the Differentiation of Postdural Puncture Headache Cerebral Venous Thrombosis and Preeclampsia: A Structured Narrative Review

Background: Headache is common after delivery, but apparently typical presentations can conceal hypertensive or cerebrovascular emergencies. Recent neuraxial anesthesia may create diagnostic anchoring and delay recognition of a second disorder. Objective: To examine the clinical differentiation of postdural puncture headache, cerebral venous thrombosis, and postpartum preeclampsia, emphasizing investigation, overlapping presentations, and time-sensitive management. Methods: A targeted PubMed-based narrative review evaluated clinical guidelines, prospective headache cohorts, retrospective obstetric studies, and contemporary cerebrovascular recommendations available through October 24, 2026. Evidence was interpreted according to population, diagnostic ascertainment, and study design; no new quantitative pooling was performed. Results: Orthostatic pain beginning after dural puncture supports postdural puncture headache, whereas new hypertension, visual symptoms, seizures, focal deficits, or a progressive or changing headache require evaluation for alternative or concurrent disease. Preeclampsia may develop after a normotensive pregnancy and does not require proteinuria when other diagnostic severe features are present. Cerebral venous thrombosis can initially present with headache alone and requires venous imaging; a normal unenhanced CT does not exclude it. Large administrative cohorts associate postdural puncture headache with rare but clinically important intracranial complications, although causality is not established. Treatment pathways differ substantially: epidural blood patch for selected disabling cerebrospinal fluid leakage, urgent blood pressure control and magnesium when indicated for hypertensive disease, and therapeutic anticoagulation for confirmed venous thrombosis. Conclusions: Differentiation depends on repeated clinical assessment rather than a single symptom. Persistent, atypical, or evolving postpartum headache warrants prompt multidisciplinary reassessment and appropriately selected neuroimaging.