HEADACHES DURING PREGNANCY

Condition

Headaches are more common in women than in men, and are most common in women during their childbearing years. When they occur during late pregnancy, headaches may be a sign of preeclampsia (toxemia), a very serious condition that can be harmful to both the mother and her unborn baby. It is therefore important to distinguish between a preeclamptic headache and other types of headache that may occur. Among these are:

• tension headache
• migraine headache
• cluster headache
• headache from injury to the head
• headache from a sinus infection (sinusitis)
• headache from eye strain
• headache resulting from caffeine or medication withdrawal.

Preeclampsia headaches

You will feel this kind of headache all over your head. It pulsates with your heartbeat and occurs with other symptoms that may include:

• high blood pressure
• protein in your urine
• sudden weight gain
• swelling of your face, hands, legs and ankles
• stomach pain
• blurred or double vision
• nausea and vomiting
• difficulty speaking
• numbness and weakness in your arms and legs

Although what causes this kind headache is not well understood, it may be related to high blood pressure or an increase in pressure and swelling in the brain.

Tension headache

Also called stress headache, this is the most common type of headache. You will feel it on both sides of your head and around the back of your neck. It is usually associated with muscle tightness in those areas and results from contraction of scalp and neck muscles, often in response to stress. A tension headache may last from a few minutes to three days. It usually occurs without other symptoms and can be very difficult to get rid of.

Migraine headaches

A migraine usually occurs on one side of your head and causes throbbing pain that may be so severe as to be disabling. The pain, which results from dilated blood vessels, can last for several hours or for up to three days. Symptoms that may occur with migraines include:

• nausea and vomiting
• loss of appetite
• fatigue
• sensitivity to light and sound
• numbness, tingling or weakness in the face or hands.

Before the pain starts, some people who get migraines experience an aura, a group of neurological symptoms, usually vision problems that serve as a warning. They may see:

• wavy or jagged lines
• flashing or blinking lights
• tunnel vision
• blind spots.

After the migraine has gone, you may have neck pain and feel sleepy or mentally dull.

The cause of migraine headaches is thought to be related to an imbalance of chemicals in the brain that effect nerve pathways. Low levels of the mineral magnesium may also be involved. Whatever the cause, migraines can be triggered by a number of things including:

• changes in the level of hormones related to menstruation and pregnancy
• some foods and beverages including chocolate, red wine, aged cheese and anything containing caffeine
• stress
• intense exercise
• some medications.

Cluster headaches

Cluster headaches are not very common in women and are rarely seen in pregnancy. These headaches occur in clusters and may appear every day at the same time for weeks, followed by a remission period lasting weeks to years before another cluster period begins.

A cluster headache usually occurs behind one eye, producing sudden, severe pain and throbbing in and around the eye. Also:

• The lid of the affected eye may swell, tear or droop.
• That side of the face may swell.
• The nasal passage on the affected side may be congested or runny.

The worst of the pain may last for a couple of hours. Nighttime attacks, which are more common than daytime ones, often begin during the dreaming period of sleep. No specific cause has been identified for cluster headaches, but the following are associated with this disorder:

• increased drinking of alcohol
• heavy smoking
• changes in your usual daily routine (such as taking a vacation or changes in your job schedule)
• changes in your sleep patterns.

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WHEN TO CALL YOUR DOCTOR FOR HEADACHES DURING PREGNANCY

Call 911 Now (you may need an ambulance) If

• You pass out with your headache.
• You have a seizure or convulsion with your headache.
• Your speech is slurred.
• There is numbness or weakness in your face, arms or legs.

Call Your Doctor Right Away (night or day) If

• You have uncontrolled vomiting.
• You are dizzy.
• You cannot walk straight.
• You have blurred or double vision.
• You have pain in your stomach.
• You continue to have a headache four hours after you have taken medication, prescription or nonprescription, for the pain.
• You have a stiff neck.
• You have a fever 100 degrees F or higher.

Call Your Doctor During Regular Office Hours If

• You need prescription medication for your headache. There are medications your doctor can order for you for your headache that are safe for you and your baby.
• The medication given to you is not working.
• You are concerned about your headache and want to see your doctor for evaluation.
• You want a referral to a specialist.
• You want a referral for acupuncture.

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HOME CARE ADVICE FOR HEADACHES DURING PREGNANCY

1. Take acetaminophen (Tylenol) for your headache. Ibuprofen (Motrin) and naproxen (Aleve) may be taken up to 28 weeks of pregnancy but are not recommended after that time because they may harm the baby. Pregnant women should avoid taking aspirin because it can contribute to bleeding and also because it can cause stomach upset.
2. Eat, sleep and exercise regularly and properly.
3. Practice correct posture with your pregnancy.
4. Try to avoid and control stress. This may involve making changes in your job or lifestyle, getting counseling, practicing biofeedback or other relaxation techniques, participating in group therapy and taking breaks at home and work.
5. Avoid alcohol, caffeine and especially smoking.
6. Rest in a quiet and dark room away from activities and noise. This can be very helpful, especially if you have migraines.
7. Avoid things that may trigger a headache. Common triggers include foods like chocolate, the food additive monosodium glutamate (MSG), unusual odors, too much exercise, high altitudes (over 5,000 feet), bright lights and certain medications.
8. Try massage for the stiff neck muscles that occur with tension headaches.
9. A hot shower may help relieve headache pain.
10. Try warm and/or cold compresses.
11. If you have recurrent headaches, keeping a headache diary will help your doctor help you. Keep track of when and how often your headaches occur, the intensity and location of the pain, possible triggers and the effectiveness of any treatment.

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For More Information Click on the Links Below

• Medline Plus Eclampsia
• Medline Plus Migraine
• American Pregnancy Association Headaches
• American Pregnancy Association Migraines

References

• American College of Obstetricians and Gynecologists, ACOG Precis V 1994, An Update in Obstetrics and Gynecology, Management of Medical Disorders, Headache, Page 43
• American College of Obstetricians and Gynecologists, ACOG Education Pamphlet AP 124, 1998, Headache.
• Wolf's Headache and Other Head Pain, Sixth Edition 1993 D.J. Daleddio, MD, S DF. Silberstein, MD.
• Up to Date, New Search Headache in Pregnancy Men-Jean lee, MD, Debra Guinn, MD, Susan Hickenbottom, MD 2006.
• Clinical Obstetrics and Gynecology Volume 48, number1, 2-11, 2005 Approach to the Pregnant Patient with Headache.

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Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional

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Revised 12/2006

Reviewed 1/2007