Headache in puerperium

BACKGROUND: Sheehan's syndrome is a rare complication of excessive postpartum hemorrhage with impaired function of the pituitary gland (hypopituitarism). Clinical presentation includes headache, fatigue, nausea, symptoms due to electrolyte imbalance and pituitary hormone insufficiency. Cranial imaging can support the diagnosis if pituitary gland ischemia or empty sella sign is detected. Therapy is based on correction of hypovolemia in the acute setting, symptom reduction and chronic hormone replacement treatment. CASE: We report a case of a patient who developed Sheehan's syndrome as a result of severe blood loss during cesarean section. Brain imaging in this case was initially performed with an alternative differential diagnosis in mind. CONCLUSION: Differential diagnosis of headache in puerperium is comprised of a spectrum of syndromes, in which attention for medical and patient history are key. In Sheehan's syndrome early diagnosis is of crucial prognostic importance.