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Pregnancy Headaches and Migraines

Headaches during pregnancy are quite common, especially during the first trimester. Changes in estrogen and other pregnancy hormones are the likely cause of pregnancy headaches. Some women, however, actually experience fewer headaches during pregnancy.

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Tension Headaches During Pregnancy

Tension headaches during pregnancy are most common during the first trimester, when hormone fluctuations are the most extreme. Women who were prone to tension headaches prior to pregnancy may experience more frequent and severe headaches during the early months of pregnancy.

Hormonal fluctuations aren't the only cause of pregnancy headaches. A number of common pregnancy complications may contribute to first trimester pregnancy headaches:

allergies
dehydration
depression
eyestrain
fatigue
hunger
lack of sleep
quitting coffee during pregnancy
sinus congestion
stress.

By the start of the second trimester, most women find the frequency of pregnancy headaches drops or even disappear until delivery, in part because estrogen levels stabilize at this point in the pregnancy.

Migraine Headaches During Pregnancy

Migraine headaches during pregnancy are difficult to predict. Between fifty to eighty percent of women who suffer from migraines find that their headaches disappear after the third month of pregnancy until delivery. As with tension headaches, changes in migraine headaches during pregnancy are thought to be due to hormonal changes.

Paradoxically, while many migraine headaches clear up during pregnancy, fifteen percent of all women suffer their first migraine headache during pregnancy, usually during the first trimester. Again, hormone changes are thought to play a role in the onset of migraine during pregnancy.

Severe Pregnancy Headaches: Migraine or Preeclampsia?

Severe headaches during pregnancy should not be ignored, especially if migraine headaches were not an issue before pregnancy. Report severe pregnancy headaches to your doctor as the headaches may indicate dangerous pregnancy complications.

Severe pregnancy headaches in the second or third trimester may be a symptom of preeclampsia, a serious complication that can threaten the life of both mother and baby. Preeclampsia is a medical emergency and should receive immediate medical attention.

As well as severe headaches, preeclampsia produces symptoms such as:

abdominal pain
hypertension
protein in urine
sudden weight gain
swollen hands or feet.

Other times to seek medical attention for pregnancy headaches include:

any headache caused by head injury
headaches accompanied by difficulty speaking, blurred visions, drowsiness, numbness, or any change in mental alertness
headaches intense enough to wake you up
headaches that get progressively worse
pregnancy headaches that feel different from your normal headaches
sudden and severe headache onset.

Treating Pregnancy Headaches

Headaches during pregnancy cannot be treated with the same range of medications available when not pregnant, as many headache medications can damage the developing fetus. Aspirin and ibuprofen cannot be used for headaches during pregnancy, nor, unfortunately, can many migraine medications.

Generally, medicine is used as little as possible for headaches during pregnancy. When needed, acetaminophen may be safely used if used exactly as directed by your doctor.

Severe pregnancy headaches and migraines may be treated with doses of codeine, oxycodine, and meperidone. These powerful analgesics can be used safely during pregnancy for short-term treatments.

Self-Care for Headaches During Pregnancy

Before resorting to medication to treat pregnancy headaches, some self-care treatment may be enough to relieve symptoms. Strategies include using alternating hot and cold compresses or taking hot showers (not a hot bath). Massage therapy may also help with some pregnancy headaches.

Dehydration is a common cause of headaches during pregnancy; so drinking sufficient water is one way to prevent headaches. Pregnancy headaches are also less likely if small, frequent meals are eaten. This prevents blood sugar levels from fluctuating, a common cause of pregnancy headaches.

Headaches After Pregnancy

Headache frequency may increase in the weeks after delivery. Estrogen levels drop after birth, and do not settle into pre-pregnancy levels for several weeks. If the mother is breastfeeding, many painkillers cannot be used, as the medication can pass to the baby through the milk. Once estrogen levels return to normal, postpartum headache frequency should return to normal.

Resources

Baby Center. (nd). Headaches during pregnancy.

Greenfield, M. (updated 2004). Headaches in pregnancy.

Greenfield, M. (updated 2004). Prevention and treatment of headache in pregnancy.

Marcus, D. (1997). Controlling headache during pregnancy.

National Headache Foundation. (nd). Pregnancy and migraine.

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