Headache is a very common complaint in the general population – therefore it is no surprise that a headache is a common complaint of the pregnant woman. The vast majority of headaches in pregnancy are benign, but there are some potentially serious causes of headaches in pregnancy that warrant urgent investigations and expert management.
What are some causes of headaches in pregnancy?
Headaches in pregnancy can be classified as primary or secondary headaches. In secondary headaches, the headaches are related to other underlining medical disorders.
Primary headaches, such as migraine and tension headache, account for most headaches in pregnancy. The majority of women with pre-existing migraine, notice a reduction in frequency and severity of attacks, possibly due to a reduction in reproductive hormonal fluctuation. However, around 10% experience a worsening of symptoms, and migraine may present de novo in pregnancy.
As well as hormonal changes, headaches in the early stages of pregnancy can be caused by an increase in the volume of blood the pregnant body is producing.
Other causes of headaches during pregnancy can include:
• not getting enough sleep
• withdrawal from caffeine (e.g. in coffee, tea or cola drinks)
• low blood sugar
• dehydration
• feeling stressed
• having depression or anxiety
In secondary headaches during pregnancy, the most common cause is pre-eclampsia and eclampsia. Pre-eclampsia may present with headache. Patients having meningitis present as headache with fever and neck stiffness.
Pregnancy significantly increases the risk of subarachnoid haemorrhage and cerebral venous thrombosis. The risk is highest in the puerperium (first 6 weeks post-delivery). These medical disorders can cause severe headache in pregnancy.
When to contact your doctor
If a pregnant woman experiences frequent headaches that do not go away with paracetamol, it could be a sign of a more serious medical condition. One of the most serious conditions is called pre-eclampsia. This usually involves an increase in the pregnant woman’s blood pressure and problems with her kidneys. Pre-eclampsia mostly occurs in the second half of pregnancy.
Contact your doctor, particularly if, along with your headaches, you have a pain below your ribs, feel like you have heartburn, you suddenly swell in your face, hands or feet, or you have problems with your eyesight.
Diagnosis and treatment
It is vital for healthcare workers to take a thorough history from any patient presenting with headache, especially if the patient is pregnant. Physical examination is often unremarkable and a good history can, in most cases, provide the information required to make the correct diagnosis. In some cases various investigations might be needed to make the diagnosis.
CT brain is safe in pregnancy, readily available, and indeed superior to MRI in detecting acute haemorrhage. The radiation dose is small and the fetal exposure is negligible. However, magnetic resonance venogram is the preferred imaging modality to detect cerebral venous thrombosis.
Treatment will depend on the exact cause of the headaches. In most cases lifestyle changes and simple analgesics might be all that is needed. In other cases other treatment options might be needed.
Analgesics and pregnancy
Most obstetricians are very cautious when prescribing any drug during pregnancy. Various drugs should only be used if medically indicated.
During pregnancy, it is essential to avoid over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or aspirin. A recent review in the Annals of Epidemiology notes that women who take NSAIDs, while pregnant, are more likely to give birth to babies with congenital abnormalities.
Some women take acetaminophen (Tylenol) while pregnant, although there is a concern that this may also affect the baby.
A recent study in the journal JAMA Psychiatry found that children born to women who take acetaminophen during pregnancy are more likely to be autistic or have attention deficit hyperactivity disorder. However, there is a need for more research into this connection before health experts can make any broad claims. Many people still view acetaminophen as the safest drug choice for women during pregnancy.
Conclusion
Experiencing a headache during pregnancy is common and not usually a cause for concern. Although headaches during pregnancy are common, it may sometimes be necessary to see a doctor. Anyone experiencing severe or continuous headaches that do not respond to home remedies should schedule an appointment with her obstetrician. Similarly, anyone experiencing other troubling symptoms — such as dizziness or changes in vision — should seek diagnosis and treatment. An obstetrician may be able to recommend a treatment that is safe for both the woman and the fetus.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-seven years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
