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Summary Headache is common in the puerperium, with a wide variety of underlying aetiologies. We describe a unique case of postpartum headache after accidental dural puncture with a Tuohy needle in a previously healthy woman during a combined spinal‐epidural for labour analgesia. Initially, a post‐dural puncture headache was diagnosed. Eclampsia was subsequently suspected after the development of complex partial seizures and proteinuria 5 days postpartum. After neurological examination and neuroimaging, however, the diagnoses of reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome were confirmed. We hypothesise that accidental dural puncture which resulted in post‐dural puncture headache may have delayed the diagnosis of other headache aetiologies and may have acted as a trigger for the development of cerebral vasospasm syndromes. This case demonstrates the importance of a careful assessment of postpartum headaches and the need for a high degree of diagnostic suspicion in cases of refractory post‐dural puncture headache. In these cases, neurological referral and neuroimaging evaluation should be considered. We highlight the importance of multidisciplinary team including anaesthetists, obstetricians and other clinicians.

69-year-old patient referred for a thyroidectomy after a positive biopsy for papillary thyroid carcinoma -Previous diagnosis of ECD -pathological evidence in an epiploon biopsy -central diabetes insipidus -diffuse vascular thickening in several territories such as cerebral, thoracic and abdominal -retroperitoneal fibrosis -pleural and pericardial thickening Background:With only around 500 cases reported in scientific literature, Erdheim-Chester disease (ECD) is an extremely rare form of CD68 positive non-Langerhans cell histiocytosis, characterized by xanthomatous infiltration of tissues in various organs. From the anaesthetic point of view, these patients should be addressed globally, given the multisystemic involvement of their pathology. 1 The reported case describes a patient diagnosed with ECD (pulmonary, endocrine and vascular disease) referred for thyroidectomy after being diagnosed with a carcinoma. To our knowledge, the only existing case report describing the anesthetic management of a patient with ECD was published in 2014. 1,3