After the mental and physical exhaustion of having a baby, the last thing you need is a headache. But postpartum headaches are a common complaint. Hormonal changes, dehydration, anesthesia, and irregular sleep patterns can all cause your baby to have headaches after delivery.
Often, rehydration, rest, relaxation, and anti-inflammatory medications (such as ibuprofen) help relieve discomfort. But sometimes postpartum women’s headaches last longer than 24 hours, are more severe than usual, and/or are not relieved by typical measures.
When this happens, you should contact your healthcare provider, as this may indicate a postpartum-specific medical condition (which is rarely life-threatening).
An earlier study reviewed the results of 95 women with postpartum headaches.The women had no previous history of epilepsy or stroke. In this study, the postpartum period was described as the period from 24 hours after delivery to within 42 days after delivery (hence a considerable period of time).
Studies have found that nearly 50 percent of women’s postpartum headaches are migraine or tension-type headaches. 24% were caused by preeclampsia/eclampsia and 16% by spinal headache. The other 10% had more serious brain abnormalities, including bleeding in the brain and stroke.
Migraine is typically unilateral in nature with nausea and/or vomiting, and sensitivity to light and sound. The pain of a migraine is often more disabling than that of a tension-type headache, which causes a dull feeling of tightness or pressure on the sides of the head. Women who experience postpartum migraines often have a history of migraines, but due to hormonal fluctuations after childbirth, postpartum may be the first.
Examples of rare but dangerous headaches that require immediate medical attention include:
- Dural sinus thrombosis
- subarachnoid hemorrhage
- pituitary apoplexy
- Arterial dissection and stroke
Another severe headache disorder that may appear after 20 weeks of pregnancy or postpartum is preeclampsia/eclampsia, the underlying signal of which is headache with high blood pressure and/or swelling of the legs and feet.
When to see a healthcare provider
A red flag warning sign to seek emergency medical care is if you have the worst headache of your life or are experiencing a thunderclap headache.
Other headache warning signs include:
- Fever and/or headache with stiff neck
- headaches related to exertion, sexual intercourse, or Valsalva maneuvers
- new migraine-like headache
- Changes in headache pain, pattern, or severity
Your healthcare provider will listen to your report of symptoms and review your medical history, and conduct a physical examination. To rule out preeclampsia, your healthcare provider will check your blood pressure and perform a urinalysis.
If you have high blood pressure and protein in your urine, your healthcare provider may give you medication to lower blood pressure and/or prevent seizures (magnesium sulfate). Brain imaging may be recommended if your symptoms do not resolve with the above treatments.
While your healthcare provider may order a brain imaging test to be on the safe side, this is usually reserved for women with worrisome signs or symptoms and headaches. For example, neurological problems such as blurred vision, difficulty walking, weakness, or numbness and tingling are a concern for blood clots or bleeding in the brain.
To rule out potentially life-threatening causes of headaches, the brain needs to be imaged using a computed tomography (CT) scan or magnetic resonance imaging (MRI). Sometimes a lumbar puncture or spinal tap is also needed.
After excluding potentially life-threatening and serious causes of postpartum headaches, the diagnosis of headache at this time may be migraine or tension-type headache. For both primary headache disorders, pain medication, fluids, and sleep are recommended.
If you are breastfeeding, be sure to consult your healthcare provider before taking any headache relief medication. Complementary therapies such as yoga, mindfulness, and breathing exercises can sometimes help relieve headaches and are safe for breastfeeding women.
If you had an epidural during labor, you may have a post-lumbar puncture headache (spinal headache). In this case, IV fluids, caffeine, or even a blood patch can help.
Blood patches require surgery to inject your own blood into the puncture site where you have an epidural. This compresses the hole, preventing any further spinal fluid leakage.
Contact your healthcare provider if you have postpartum headaches, or your nurse if you are still in the hospital. There may be a simple solution, such as sleep, fluids, or pain medication.
However, your healthcare provider will want to make sure nothing more serious happens. As a parent, you need this reassurance too, so you can get proper headache relief and get back to enjoying your newborn.
Frequently Asked Questions
Do postpartum hormones cause headaches?
Yes, many women experience headaches in the days and weeks after giving birth. Postpartum hormonal fluctuations can cause headaches. Other contributing factors include dehydration, the consequences of anesthesia or pain medication, and changes in sleep patterns.
How long do postpartum headaches last?
The postpartum period lasts about six weeks, from 24 hours postpartum to 42 days postpartum. Any headache during this period is considered a postpartum headache. Migraine and tension-type headaches were also more common during this period.
Individual headaches may come and go on a regular or irregular basis. If the headache persists without relief for more than 24 hours, call your doctor.
When should you worry about postpartum headaches?
Postpartum headaches can be a sign of serious problems. Call your doctor if you experience any of the following:
- headache lasting more than 24 hours
- Fever or neck stiffness with headache
- The pain is worse than usual, sometimes called a thunderclap headache
- Typical measures such as hydration, rest, relaxation, or over-the-counter headache medications do not relieve pain