Evaluation of headaches during pregnancy

While many new symptoms can appear during pregnancy, such as weight gain, acid reflux, and back pain, existing medical conditions can also worsen or improve.

Migraine headaches, for example, tend to improve during pregnancy, especially in the second and third trimesters. Other conditions, such as pregnancy-specific headache disorders, may also occur.

Headache Assessment During Pregnancy

When evaluating your headache, your healthcare provider will perform a detailed medical history. She may ask you questions about any medical conditions you have, such as high blood pressure or depression, or if you are taking any medications or over-the-counter supplements, such as vitamins, caffeine, or laxatives.

Your healthcare provider will also ask about the characteristics of your headache, such as how severe it is, how long it lasts, or if you have associated symptoms such as nausea or vomiting. This is done to make an accurate diagnosis, as well as to assess headache warning signs and rule out medical emergencies.

Some specific headache warning signs that require immediate medical attention (which may indicate a dangerous headache during pregnancy) include:

  • “The worst headache of my life”
  • blurred vision
  • neurological symptoms, such as weakness or numbness
  • Fever and/or headache with stiff neck
  • headache with high blood pressure and/or swelling of the legs and feet
  • headaches related to exertion, sexual intercourse, or Valsalva maneuvers
  • new migraine-like headache
  • Changes in headache pain, pattern, or severity

Primary headaches during pregnancy

The three most common primary headache disorders are migraine, tension-type headache, and cluster headache. While women may develop new headache disorders during pregnancy, often these disorders are already present. In addition to migraines, tension-type headaches and cluster headaches tend to remain stable during pregnancy.

Migraines are the most common headaches during pregnancy, but are generally less severe and less frequent than headaches outside of pregnancy. That said, migraines may initially worsen in the first trimester, especially as hormone levels in the body change and stress increases.

There is some scientific evidence that women with migraines may be at higher risk for preeclampsia and/or preterm labor, although more research needs to be done to tease out this relationship.

Headache due to preeclampsia/eclampsia

Pre-eclampsia and eclampsia are serious conditions that can occur after 20 weeks of gestation and/or during the postpartum period. Preeclampsia can cause high blood pressure and protein in the urine.

In addition to very high blood pressure, severe preeclampsia may cause the following symptoms:

  • low urine output
  • liver problems
  • Vision change
  • low platelet count

Eclampsia is a potentially fatal condition that occurs when women experience seizures, blindness and/or coma in the face of severe preeclampsia.

In pre-eclampsia and eclampsia, headache is a common symptom that may resemble a migraine, usually characterized by a throbbing sensation, with nausea and photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound) .

Unlike migraines, however, preeclampsia-related headaches can be associated with other worrisome features, such as blurred or double vision and abdominal pain. Also, while migraines tend to occur on one side of the head, headaches from preeclampsia can spread throughout the body.

According to an article headachewomen with a history of migraines were almost four times more likely to develop preeclampsia than women without a history of migraines.

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For high-risk groups, daily low-dose aspirin is recommended to help prevent preeclampsia and its associated complications. It is recommended to start this treatment between 12 and 28 weeks of pregnancy, but preferably before 16 weeks of pregnancy.

In addition to magnesium sulfate, calcium channel blockers, and possibly other antiepileptic drugs, treatment of preeclampsia and eclampsia usually involves labor.

idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a serious medical disorder that commonly occurs in obese women of reproductive age. It can occur in any trimester of pregnancy.

IIH can cause headaches, vision changes, and pulsatile tinnitus (when people hear rhythmic sounds that match their heartbeat). Brain imaging in a patient with IIH is normal, but cerebrospinal fluid pressure is elevated at the time of lumbar puncture.

In addition, women with IIH have papilledema — a disease characterized by swelling of the optic nerve in the eye due to increased fluid pressure in the brain. Overall, treatment of IIH is aimed at weight loss or control and reduction of elevated intracranial pressure. However, since weight loss during pregnancy is not recommended, other treatment options will be used.

Sometimes intracranial hypertension is caused by another disorder – this is called secondary intracranial hypertension. The most common cause of secondary intracranial hypertension is cerebral venous thrombosis, which can occur at any stage of pregnancy but is most common postpartum.

reversible cerebrovascular syndrome

Reversible cerebrovascular syndrome, also known as Call-Fleming syndrome, is another headache syndrome that can be triggered by pregnancy and can also occur postpartum. People with this headache syndrome are often described as thunderclap headaches, which are severe, sudden, and explosive headaches.

The cause of this syndrome is unknown, but it is believed that the origin of the pain is related to the spasms of the arteries in the brain. Treatment is with calcium channel blockers, which are blood pressure drugs that help dilate or open arteries in the brain.

Remember, if a woman comes to the emergency room with a thunderclap headache, an exhaustive approach must be taken to rule out subarachnoid hemorrhage before presuming the woman has reversible cerebrovascular syndrome.

other reasons

In addition to the headache disorders mentioned above, there are other potentially dangerous causes of headaches such as stroke, meningitis, carotid or vertebral artery dissection, and pituitary stroke. There are also underlying benign causes, such as sinusitis, post-lumbar puncture headache, or medication withdrawal headache.

VigorTip words

Finally, most headaches during pregnancy are not dangerous. However, if you have headaches during pregnancy that are not relieved by simple remedies such as cold compresses, sleep, caffeine (if you suspect a caffeine withdrawal headache,) relaxation and/or food, or if your headaches follow a different pattern or headache warning signs, be sure to contact your healthcare provider right away.