Many women experience headaches during their pregnancy. In fact, some research has shown that 39% of women may experience some sort of headache or migraine during their pregnancy during their postpartum. The sensation and type of headaches that women experience during their pregnancy may be different, but generally, pregnancy headaches should not raise too much alarm. Generally speaking, many women who suffer from frequent headaches before pregnancy often note that these decrease in severity and intensity because of increased estrogen throughout the body. Menstrual migraines are typically caused by the drop in estrogen prior to the menstrual cycle. So if with a sustained level of estrogen, that trigger is eliminated during pregnancy.
For the majority of women (60-70%), migraines improve during pregnancy, particularly in the 2nd and 3rd trimester. It is not uncommon to hear women mention that their migraines were gone during pregnancy. Unfortunately, it is also not uncommon to hear that the migraines come roaring back after delivery and hormonal shifts move back to normal. The women that tend to improve during pregnancy are those that have migraine without aura, migraines related to menstrual cycles, and migraines that began with menarche (when menstrual cycles began). With that said, 4-8% of women have worsening migraines during pregnancy.
What Types of Headaches Are Common During Pregnancy and Postpartum?
Primary headaches are the most common type of pregnancy and postpartum headaches. These are primarily migraine and tension-type headache. Some of the symptoms that you may experience as a result of a pregnancy headache or migraine include a dull ache or pressure (tension type headache), a pulsating or throbbing pain (migraine), and a sharp pain around one or both eyes (typically migraine).
About 25% of these headaches in pregnant women are tension headaches. Secondary headaches that occur during pregnancy are less common and may be related to circulatory issues such as high blood pressure (pre-eclampsia, eclampsia) and low iron levels. Idiopathic intracranial hypertension (IIH), previously called pseudotumor cerebri, can sometimes also occur or worsen during pregnancy. Less common but serious medical causes could also include cerebral venous thrombosis (blood clot in the large veins of the brain). Any change of headache pattern or new headache development during pregnancy requires an evaluation with your doctor.
Pregnancy Headaches By Trimester
Depending upon which trimester you are in, the cause of your headaches and the accompanying symptoms will be different. Hormonal changes, higher blood volume, and weight gain/loss are contributors to headaches during your first trimester. Some of the causes of these headaches might include dehydration, nausea, stress, vomiting, lack of nutrition, low blood sugar, and other issues.
During your second and third trimesters of pregnancy, you might have different causes of your headache. Weight gain, posture, lack of sleep, muscle strain and tightness, and other issues are the biggest causes of pregnancy headaches during this period.
Throughout your pregnancy there are certain foods that can also cause headaches and be migraine triggers. These include chocolate, dairy products (milk and cheese), anything with yeast, tomatoes, and certain other food items. Caffeine can also increase the likelihood of a headache during your pregnancy.
When Should You Worry About Headaches During Pregnancy?
More intense and frequent headaches that happen during your 2nd and 3rd trimesters could be indicative of high blood pressure. This condition is not common and impacts about 8 percent of pregnant women who are between 20 and 44. High blood pressure could cause serious complications for both the mother and child. Preeclampsia, stroke, premature delivery, low birth weight, and preeclampsia or eclampsia odds are higher for pregnant women with high blood pressure.
When you have a severe headache during pregnancy that causes dizziness, blurred vision, and other issues, you must see your doctor. If it comes on abruptly, you should see a doctor in the emergency room. Headaches during the 2nd and 3rd trimester with greater frequency and intensity could increase the risk of stroke if they are related to high blood pressure or cerebral venous thrombosis. As mentioned above, any change in your normal headache pattern, or development of new headaches during pregnancy, needs to be discussed and evaluated with your doctor. Some women can develop or exacerbate symptoms of idiopathic intracranial hypertension (IIH), which was previously called pseudotumor cerebri. This is caused by high pressures of the cerebrospinal fluid (CSF) around the brain. Symptoms consist of daily or frequent headaches along with visual disturbances such as blurred vision, persistent areas of lost vision, and frequent brief episodes of visual black outs, grey outs or blurring lasting 5-15 seconds called transient visual obscurations (TVOs).
Dealing With Headaches During Pregnancy
You should avoid any known headache triggers, especially certain types of foods. These include MSG, cured meats, strong cheeses, certain dairy products, anything with yeast, and caffeine. Avoid secondhand smoke, as this can cause headaches. Eat well and drink plenty of fluids, which will help reduce morning sickness. When you are pregnant, avoid stress. Massages and cold (or sometimes warm) presses will also help deal with headaches, especially tension headaches. Cool, dark rooms with no noise will help with migraines, as well as other conservative treatments.
Abortive (As-Needed) Medications for Headaches and Migraines During Pregnancy
Overall, acetaminophen is fairly safe to take for headaches during pregnancy. Up to the third trimester (32 weeks), NSAIDs are considered safe, as well. After the third trimester (after 32 weeks), ibuprofen and other NSAIDs can put the baby at risk. NSAIDs can cause a serious issue affecting the blood pressure in your baby’s lungs. Additionally, NSAIDs used late in pregnancy cause issues with amniotic fluid and make for an elongated labor.
Triptans have historically been avoided in pregnancy due to theoretical concern that their vasoconstrictive (blood vessel narrowing) effects may result in less blood flow to the placenta and baby. However, many physicians are increasingly using triptans during pregnancy now given some evidence suggesting they can be used safely and anecdotal evidence that they appear generally safe, although more research is needed. Some antiemetics are used during pregnancy for not only nausea, but also some abortive benefit. Metoclopramide has generally been felt to be the safest antiemetics and most often used in this scenario. Currently, it is recommended to avoid the gepants (Nurtec ODT and Ubrelvy) during pregnancy and breastfeeding because there is not enough safety data at this time.
Preventive Medications for Headaches and Migraines During Pregnancy
Magnesium supplementation is often recommended as a preventive migraine treatment both during pregnancy and outside of pregnancy. Other medications sometimes used for migraine prevention if needed include cyproheptadine (although it should be stopped when breastfeeding starts to avoid sedation in the baby), metoprolol, and some SSRI type antidepressants. Current recommendations are that CGRP monoclonal antibodies (Aimovig, Emgality, Ajovy, Vyepti) are not used during pregnancy or breastfeeding because there is not enough safety data at this time. In addition, CGRP is suspected to play a possible role in regulating uteroplacental blood flow, myometrial and uterine relaxation, and in maintaining normal gestational blood pressure. Since the CGRP mAbs have a long half-life and can last in the system for 5 months, it is recommended to stop it about 6 months prior to pregnancy planning. Historically, Botox has generally been avoided in pregnancy, although some physicians are increasingly using it during pregnancy for refractory chronic migraine.
Non-Medication Treatments For Headaches During Pregnancy
There are certain types of non-medication treatments that may also help with headaches and migraines during pregnancy. These include activities and therapies aimed at lowering stress such as mindfulness, relaxation,biofeedback, yoga and meditation, acupuncture, acupressure and pressure points. Sometimes exercise or physical therapy can be helpful. Neuromodulation devices, trigger point injections, or nerve blocks such as occipital nerve blocks can also be helpful. Essential oils are also a great way to help reduce headaches.
Outlook for Headaches During Pregnancy
If you are pregnant, your outlook is good in terms of headaches and migraines. These conditions happen because of the changes the body is going through in a relative short period of time. Always consult with a health professional during pregnancy if you are going to take medications for headaches and migraines because there are certain medications to avoid, especially during the later stages of pregnancy. Also, headaches further on in pregnancy might be indicative of a more serious health issue, like high blood pressure.
Generally speaking, consult with a doctor before taking any medications. Also, tell your provider if your headaches change in frequency or intensity. Also, check with your doctor if you are getting headaches that come with blurred vision, weight change, pain in the upper right abdomen, and swelling.
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