Worsening headache after giving birth: a case report
A 32-year-old woman presented to the emergency department 8 days after vaginally delivering her second child complaining of gradually worsening generalized headache that started the night before her visit. She denied fever, vomiting or stroke-like symptoms. She also described pleuritic bilateral rib pain that is worse on the right and is associated with shortness of breath and leg edema. She denies other complaints.

The patient's vital signs included the following: pulse 58 bpm, blood pressure 177/95 mm Hg, respiratory rate 22, and temperature 97.8◦F. Physical examination was normal except for diminished breath sounds on the right and 1+ bilateral pitting leg edema without redness. Neurologic exam was normal.

Laboratory workup was normal except for D-dimer >20, aspartate aminotransferase (AST) 100 U/L, and alanine aminotransferase (ALT) 150 U/L. Electrocardiography showed sinus bradycardia.

The radiograph depicted a small right pleural effusion. The patient was admitted for pre-eclampsia and treated with magnesium. CT imaging of the chest was negative for pulmonary embolism or liver pathology but did reveal small bilateral pleural effusions. CT of the head was negative for bleeding or venous sinus thrombosis.

Blood pressure and headache improved with treatment; AST and ALT increased slightly on day 1 of treatment but then improved.

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