Pregnancy Headaches – Causes, Treatment, Prevention

Headaches can be distressing during pregnancy but in most cases the reason may be a simple one, such as headache due to stress, which normally does not cause any harm to the mother or baby. Prevention of the more serious causes of headaches, such as hypertension during pregnancy, which can have more dangerous consequences such as pre-eclampsia, should be the focus. As a rule, headaches in the third trimester may have a more sinister cause than headaches in the first trimester of pregnancy.

Causes of Pregnancy Headaches

Pregnancy Related Causes

  • Hormonal changes are normal during pregnancy may be the main cause for pregnancy headaches, especially in the first trimester of pregnancy.
  • Increased blood volume which is a normal part of pregnancy.
  • Dehydration as a result of inadequate water intake or severe morning sickness (hyperemesis gravidarum)  with excessive vomiting.
  • Tension headaches may be due to various forms of stress and worry. Concerns about pregnancy related issues or other stresses in life complicated by the pregnancy may add further stress to the mother.
  • Insufficient sleep which may be associated with pregnancy or physical changes that occur as a part of pregnancy.
  • Fatigue is a common part of pregnancy due to the increased demands on the body. A headache may often accompany fatigue.
  • Anemia refers to low iron levels in the body, which is common in pregnancy, can cause fatigue, dizziness and headaches.
  • Migraine. Women who suffer from migraine headaches before pregnancy usually find that their symptoms improve during pregnancy, but in some women there may be no changes at all or the headaches may worsen.
  • Substance withdrawal symptoms. Pregnant women may discontinue nicotine and caffeine intake during pregnancy an this can result in headaches. Other substances like alcohol, narcotic and prescription drugs may also be responsible for headaches once these substances are discontinued.
  • Depression which may be pre-existing may become worse in pregnancy due to a number of physiological and psychosocial factors or depression may start up in pregnancy (antepartum depression).
  • Hypoglycemia or low blood sugar may arise in pregnancy for a number of reasons including a loss of appetite due to morning sickness or persistent nausea, dieting during pregnancy to prevent excessive weight gain or insufficient food intake. Hunger for the same reasons may also result in a headache even though the blood glucose levels are within a normal range.
  • Poor posture, especially in the third trimester, may cause spasm of the neck and/or back muscles.
  • Sinusitis and other causes of nasal congestion, like allergic rhinitis, may be aggravated in pregnancy due to hormonal changes or discontinuing chronic medication which was suppressing the symptoms.
  • Hypertension in pregnancy and pre-eclampsia
    • Persistent headaches, usually in the second half of pregnancy, could be a sign of high blood pressure or pre-eclampsia.
    • Hypertension in pregnancy and pre-eclampsia are potentially dangerous conditions that can develop during pregnancy, which can harm both the mother and baby.
    • Often, hypertension does not produce any symptoms and may be an incidental finding during prenatal check up, but sometimes it presents as headaches in pregnancy.
    • Pre-eclampsia may proceed to eclampsia, a more dangerous complication, where the symptoms of pre-eclampsia are present along with the development of seizures. This can be extremely hazardous for mother and baby.

Other Causes

There are a number of other causes of a headache and head pain which may be unrelated to pregnancy. These causes are covered in the following articles :

  1. Head Pain Causes
  2. Headache Causes, Symptoms, Diagnosis, Treatment, Prevention
  3. Headaches and Dizziness (Light Headed, Vertigo) Causes
  4. Headache, Nausea and Vomiting
  5. Constant Headache – Causes of Persistent, Continuous Headaches

Treatment and Prevention of Pregnancy Headaches

Treatment and prevention of headaches in pregnancy often go hand in hand, such as following certain life-style adjustments.

Drugs for Headaches during Pregnancy

  • Antidepressants such as amitriptyline and fluoxetine are relatively safe drugs which may be used in pregnancy to prevent migraine.
  • Beta blockers such as propranolol, labetalol, and atenolol may also be used. However, it needs to be stressed that any medication used in pregnancy should be prescribed by a doctor.
  • A severe acute attack of migraine may be treated with intravenous fluids (to maintain hydration), antiemetics (to control vomiting) such as prochlorperazine and promethazine, pain relievers and steroids.
  • Ergotamines are contraindicated in pregnancy.
  • Sumatriptan and naratriptan may be used with caution.
  • Pain relievers such as aspirin and ibuprofen are usually not recommended during pregnancy, although ibuprofen may sometimes be used before the third trimester.
  • Acetaminophen may be used safely in the prescribed doses.

Management

  • Adequate rest.
  • Getting sufficient sleep.
  • Resting in a dark room.
  • Maintaining good posture, especially in the last trimester.
  • Balanced diet.
  • Eating at regular intervals.
  • A cup of coffee may help, if the headache is due to caffeine withdrawal, however it is best to avoid caffeine. Speak to a doctor about any nicotine replacement products (NRT) if the headache may be related to the cessation of cigarette smoking.
  • Proper exercise.
  • Relaxation techniques for relieving stress, such as yoga and meditation.
  • For migraine headaches – avoiding potential triggers such as chocolates, caffeinated drinks, cheese, peanuts, preserved meat, and alcohol. Prevention of migraine should be the aim.
  • Bed rest, low salt diet, and reducing stress may be useful in controlling hypertension. Antihypertensives (blood pressure lowering drugs) may be needed in some cases. Methyldopa is considered safe to be used in pregnancy and is usually the first line of treatment.

It is of utmost importance to remember not to take any medications during pregnancy without the doctor’s advice. See a doctor as soon as possible if :

  • The headache is persistent and does not get better with home treatment.
  • The headaches become worse or are more severe than normal.
  • The headaches (especially if in the second half of pregnancy) are accompanied by sudden weight gain, edema or swelling of the hands and face, dizziness, blurred vision, and pain abdomen. These could be signs of pre-eclampsia, which needs immediate medical care.
  • There is fever or neck stiffness along with a headache.
  • Development of a new and severe type of headache.

Reference

  1. Neurologic Disease and Pregnancy. Emedicine Medscape

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