Headaches and fatigue during pregnancy

[Headache, fatigue and edema of the lower limbs during the third trimester of normal pregnancy]

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. 1996 Nov 18;158(47):6778-80.

[Article in Danish]

M Lebech¹, M Hansen, A Knudsen

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Affiliation

¹ Gynaekologisk-obstetrisk afdeling, Hjørring/Brønderslev Sygehus.

PMID: 8992699

[Article in Danish]

M Lebech et al. Ugeskr Laeger. 1996.

. 1996 Nov 18;158(47):6778-80.

Authors

M Lebech¹, M Hansen, A Knudsen

Affiliation

¹ Gynaekologisk-obstetrisk afdeling, Hjørring/Brønderslev Sygehus.

PMID: 8992699

Abstract

A series of 180 pregnant women with normal pregnancies participated in the study. A questionnaire concerning the presence of headache, fatigue and oedema of the lower limbs was filled out daily from the 30th gestational week to delivery. After the study period 120 questionnaires, of whom eight were excluded, were available for analysis. The weekly prevalences of headache and fatigue during the observation-period were nearly constant with values of 20% and 50%, respectively. The weekly prevalence of oedema increased significantly from 20% in the 31st week to 60% in the 42nd gestational week. Thirty-five percent had not suffered from headache, 22% did not report fatigue, and 42% did not describe oedema at all during the third trimester. The prevalence of headache and fatigue correlated significantly to increasing parity whereas headache was significantly correlated to decreasing age. Headache, fatigue, and oedema are common symptoms in the third trimester of normal pregnancy, and as such their presence alone should not usually give cause for suspicion of disease.

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Headache during pregnancy: Symptoms, treatments, and remedies

Pregnancy
Your Body

By Hallie Levine

November 29, 2021

A mild headache during pregnancy is normal, especially in the first trimester as your hormone levels fluctuate. Tension headaches are common, while some women might experience their first migraine during pregnancy. (On the flip side, many women find that pregnancy makes their migraines go away!) If you have a severe headache in the second or third trimester, call your healthcare provider right away, as it could be a sign of preeclampsia. Otherwise, exercising, changing your sleep habits, and taking acetaminophen (with your doctor's okay) are some safe ways to treat pregnancy headaches.

Photo credit: iStock.com / damircudic

What causes a headache during pregnancy?
Common types of pregnancy headaches
Is it common to get a migraine during pregnancy?
What can I take for a headache while pregnant?
Other ways to prevent or treat a headache during pregnancy
When should I be worried about headaches during pregnancy?

What causes a headache during pregnancy?

Pregnancy headaches are a common experience, especially in the first trimester. You can blame your hormones: Some women are more sensitive to the increase in estrogen that occurs during pregnancy. You may also notice more headaches in early pregnancy thanks to an increase in blood volume during the first trimester, or if you're quitting or cutting back on caffeine – the withdrawal can make your head pound.

Other possible causes of pregnancy headaches include:

A lack of sleep or general fatigue
Sinus congestion or a stuffy nose
Allergies
Eyestrain
Stress
Depression
Hunger
Dehydration

It's normal to get tension headaches when you're pregnant, especially in the first trimester. Migraine sufferers usually get some relief when they're expecting – although some women may actually end up getting their first migraine during pregnancy.

If you have headaches in your first trimester, you'll probably find that they decrease or even disappear completely during the second trimester, after the flood of hormones stabilizes and your body gets used to its altered chemistry.

Common types of pregnancy headaches

There are many different types of headaches you may experience while pregnant, and it isn't always easy to tell which kind you have. Here, a few key differences:

Tension headaches are one of the most common kinds of headaches during pregnancy, especially in the first trimester. They can feel like a squeezing pain or a steady dull ache on both sides of your head or at the back of your neck. If you've always been susceptible to tension headaches, pregnancy can make them worse.

Sinus headaches typically feel like pressure or pain in your cheeks, around your eyes, and in your forehead. They occur most often after you've had a cold or a respiratory infection. People commonly mistake migraine headaches for sinusitis – if you're getting more headaches but otherwise have been healthy, you might be having migraines. But if you're feeling congested, you might have a sinus infection requiring treatment.

Cluster headaches are much less common, and experts aren't sure if pregnancy affects the frequency or intensity of them. Cluster headaches are marked by sudden, severe pain usually around one eye or temple, sometimes with teary eyes or a stuffy nose. They tend to occur at the same time each day, often a few hours after falling asleep, over weeks or months.

Migraine headaches cause moderate to severe throbbing pain, typically on one side of the head. They can also be accompanied by other symptoms, such as nausea, vomiting, or sensitivity to light and noise. If untreated, they can last from four to 72 hours and may be aggravated by physical activity as well as many of the same factors that trigger more typical headaches. Migraines are most common in the first trimester, and tend to ease up in the second and third trimester, as your body adjusts to hormones.

Some migraine sufferers have a condition known as migraines with aura – that is, headaches that are preceded by symptoms that may include visual changes (such as bright flashing lights or blind spots), sensations of numbness or "pins and needles," weakness, and speech disturbances. These symptoms may start up to an hour before a migraine starts and may last as long as an hour.

Is it common to get a migraine during pregnancy?

The frequency of pregnancy migraines varies. Experts estimate that about 1 in 5 women will have a migraine at some point in their life, and studies have shown a small number of women experience their first migraine while pregnant, most often in the first trimester.

Some good news about migraines during pregnancy: In one study, about two-thirds of women who were prone to migraines noticed that their migraines actually improved when they were pregnant. (This is more likely to happen if your migraines tend to be worse around the time of your periods or start when you first begin menstruating.) Other women noticed no change or found that their migraines become more frequent and intense.

However, women who have migraines tend to have higher rates of preeclampsia, a serious high-risk pregnancy condition marked by high blood pressure – especially if they didn't get migraines before pregnancy – so it's important to let your healthcare provider know if you suddenly start having them.

What can I take for a headache while pregnant?

It's always best to talk to your healthcare provider before taking any medicines while you're pregnant, but when it comes to headache relief, acetaminophen (Tylenol) is considered the safest over-the-counter pain reliever to take during pregnancy, if used as directed. Don't exceed the recommended daily dose, and because acetaminophen may not be safe to take for prolonged periods, take it only as it's needed.

If your headaches aren't getting any better, your ob-gyn or midwife may be able to prescribe some other safe options, so talk to them.

If you're prone to severe migraines, ask your provider which medications you can take. One well-known class of migraine drugs, triptans, have been generally shown to be safe during pregnancy, but you may need to be monitored by a maternal-fetal medicine specialist (MFM) or a neurologist during your pregnancy if you're taking them.

Other ways to prevent or treat a headache during pregnancy

Here are some more ways to find pregnancy headache relief:

Figure out your headache triggers. Headache specialists often recommend keeping a headache diary to help you identify specific triggers. The next time you get a migraine or headache, write down everything you ate for the 24 hours prior and what you were doing when your headache started.

Some common migraine triggers include foods that contain:

Monosodium glutamate (MSG)
Nitrites and nitrates (common in processed meats like hot dogs, salami, and bacon)
Artificial sweeteners

Other foods that can trigger a headache include:

Certain beans and nuts
Aged cheeses and cultured dairy products (like buttermilk and sour cream)
Some fresh fruits (including bananas, papayas, avocados, and citrus)
Smoked fish
Chocolate and carob
Fermented or pickled foods (like soy sauce or sauerkraut)

Other triggers may include:

Glaring or flickering lights
Loud noises
Excessive heat or cold
Strong odors
Fasting
Tobacco smoke

Use a compress. You may be able to find relief if you apply a warm or cool compress to your forehead or the base of your skull.

Take a shower. For some migraine sufferers, a cold shower brings fast – if temporary – headache relief. If you can't take a shower, splash cool water on your face. A warm shower or bath can soothe tension headaches.

Don't go hungry or thirsty. To prevent low blood sugar (a common headache trigger), eat small meals frequently. When you're on the go, take along some healthy snacks, such as crackers, fruit, or yogurt. Stay away from straight sugar, like candy or soda, which can make your blood sugar spike and crash.

Don't forget to drink plenty of water and stay hydrated. Sip water slowly if you've recently vomited from a migraine.

Avoid fatigue. Get plenty of sleep at night. When you're having a migraine, it might be helpful to sleep in a quiet, dark room.

Exercise. Some evidence shows that regular exercise during pregnancy can reduce the frequency and severity of migraines and reduce the stress that can cause tension headaches. If you're prone to migraines, get started slowly – a sudden burst of activity could trigger one. (And don't exercise once a migraine has started because it will aggravate the headache.)

Exercises to help you maintain good posture may be especially helpful with headaches during the third trimester.

Try relaxation techniques. Biofeedback, meditation, prenatal yoga, and self-hypnosis may be helpful for reducing stress and headaches in some sufferers.

Get a massage. Some women who suffer from tension headaches swear by massage, although it's unclear whether it's effective in preventing or relieving headaches. A full-body massage (ideally from a therapist who specializes in prenatal massage) can release tension in the muscles of your neck, shoulders, and back.

If a professional massage isn't an option, ask your partner to rub your back and head.

Consider acupuncture. Acupuncture treatment is generally considered safe during pregnancy, although whether it can provide pregnancy headache relief is a topic of debate. If you'd like to try it, ask your healthcare provider for a referral and keep them posted on your treatments. If you prefer to see an acupuncture practitioner who's also an M.D., check out the American Academy of Medical Acupuncture.

When should I be worried about headaches during pregnancy?

In the second or third trimester, a severe headache could be a sign of preeclampsia. Other symptoms of preeclampsia include an unusual amount of protein in the urine, vision changes, and liver and kidney abnormalities.

Call your healthcare provider right away if:

You're in your second or third trimester and have a bad headache or a headache for the first time. It may or may not be accompanied by visual changes, sharp upper abdominal pain or nausea, or swelling in your hands or face. You'll need to have your blood pressure and urine checked right away to be sure you don't have preeclampsia.
You have a headache (even a mild one) and you've been having high blood pressure.
You have a sudden "explosive" headache. This type of headache is a violent pain that wakes you up, doesn't go away, or feels unlike anything you've ever experienced.
Your headache is accompanied by a fever or a stiff neck.
Your headache gets worse and you have other problems, such as blurry vision or other visual disturbances, slurred speech, drowsiness, numbness, or a change in sensation or alertness.
You have a headache after any kind of head injury.
You have nose congestion, as well as pain and pressure underneath your eyes or other face or tooth pain. (This could be a sinus infection that calls for antibiotics.)
You notice any abnormal changes in vision, such as getting headaches after reading or looking at a computer screen.

In any case, don't hesitate to call your ob or midwife whenever you're worried about a headache during pregnancy. Even if you've had headaches before, talking to them can help you decide which treatment might be best for you while you're pregnant.

Read More:

Your first trimester pregnancy checklist

Pregnancy symptoms you should never ignore

Common pregnancy aches and pains

Sources

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

American Academy of Otolaryngology-Head and Neck Surgery. Undated. Sinus headaches. http://www.entnet.org/content/sinus-headaches [Accessed October 2021]

American College of Obstetricians and Gynecologists. 2019. Chronic Hypertension in Pregnancy. Washington, D.C. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/01/chronic-hypertension-in-pregnancy [Accessed October 2021]

American College of Obstetricians and Gynecologists. 2020. Preeclampsia and high blood pressure during pregnancy. https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy [Accessed October 2021]

American Migraine Foundation. Sinus headaches. https://americanmigrainefoundation.org/understanding-migraine/sinus-headaches/ [Accessed October 2021]

American Migraine Foundation. 2017. Migraine and pregnancy: How hormones affect head pain. https://americanmigrainefoundation.org/resource-library/migraine-pregnancy-hormones/ [Accessed October 2021]

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Journal of Injury and Violence Research. 2012. Review of headache in pregnancy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571605/ [Accessed November 2021]

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Headache during pregnancy: where does it come from and how to get rid of it

When to call an ambulance

Urgently dial 103 or 112 if you have ^{Clinical guidelines for the diagnosis and treatment of tension headache the following symptoms:}

sudden and severe headache;
consciousness ^{Preeclampsia becomes confused or lost altogether;}
pain worsens over 5 minutes;
flies, spots flash in the eyes;
throbbing and noisy in the ears;
speech has become slurred, words are drawn out;
arms and legs weaken, convulsions set in;
severe neck stiffness ^{Meningitis, chin cannot reach chest;}
fever ^{ALGORITHMS for providing emergency medical care outside a medical organization 39°C and above;}
increased heart rate at rest;
severe shortness of breath;
the child pushes without stopping or suddenly stops;
leaking ^{High blood pressure and pregnancy: Know the facts of water or blood;}
lower abdomen hurts, as if contractions had begun.

Why pregnant women can get headaches

Pregnancy headaches are not always life threatening. But the doctor needs to be told about it in any case. If the symptom appeared for the first time and does not hurt much, postpone the conversation until a scheduled visit. If your headache is recurring or gets worse, it's best to make an appointment as soon as possible. The gynecologist will decide what needs to be done or refer you to another doctor.

There are many causes of headaches. Scientists have found ^{Characteristics and diagnoses of acute headache in pregnant women — a retrospective cross‑sectional study that in pregnant women in 57% of cases it is primary, that is, not associated with other diseases. The most common are migraines and tension headaches.}

Everything else is a secondary headache caused by various pathologies. Usually it is high blood pressure and infections. But there are also more dangerous reasons.

1. Stress and fatigue

A pregnant woman's body experiences increased stress, because it has to work for two. If at the same time the expectant mother is exposed to stress, strong feelings or sleeps little, she gets ^{Clinical guidelines for the diagnosis and treatment of tension headache tension headache.}

Discomfort lasts from 30 minutes to several days. The head hurts in the forehead, occiput, both temples. But there is no feeling that they put on a tight hoop or helmet. The pain does not get worse when bending over, walking, or climbing stairs, bright lights, or sounds.