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Postpartum headache (PPH) caused by internal carotid artery dissection (ICAD) is a rare yet treatable condition with a favorable prognosis when recognized. The consequent hypoperfusion or subsequent distal embolization may lead to an ischemic stroke which is already a recognized risk in the puerperium. Pregnancy and puerperium increase the risk for focal ischemic cerebrovascular events. The hypercoaguable state in pregnancy and the immediate puerperium most certainly contributes to this risk. Extracranial ICAD usually presents as a headache, cervical pain, Horner's syndrome, or pulsatile tinnitus without cerebral ischemia. Magnetic resonance imaging (MRI) can visualize morphological details, while magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) reflect intraluminal blood flow. Surgical intervention in ICAD is only required when anticoagulant therapy does not prevent progressive cerebral ischemic events. Teratogenic effects are severe and include anencephaly and spina bifida.