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Headaches in pregnancy - Should I be worried?

Maternity care is still essential during the coronavirus pandemic and services are still running. If you have any concerns about your pregnancy call your GP, midwife, nearest early pregnancy unit or maternity unit.

How can I treat a headache in pregnancy?

If you have a mild headache, it’s safe to take paracetamol. Make sure you follow the instructions on the packet for how much you can take.

There are some painkillers you should not take while you’re pregnant. These include tablets or capsules that:

• contain added caffeine (sometimes sold with 'extra' on the label)
• contain codeine
• are anti-inflammatory, like ibuprofen or aspirin.

Some women may be advised to take a low dose of aspirin as a treatment if they have had miscarriages before or they are at risk of pre-eclampsia. This will be prescribed by a doctor. Aspirin should not be taken as treatment for a headache.

Try to take the lowest dose of paracetamol that works and for the shortest amount of time. Your midwife, GP or pharmacist can give you more advice if the pain is ongoing and doesn’t go away with paracetamol.

Find out more about drugs and medicines in pregnancy.

 There are some things you can do to prevent headaches. Try to:

• drink at least eight glasses of fluid a day to avoid dehydration
• get enough sleep
• eat a healthy, balanced diet
• rest and relax  as much as possible. You could try things like mindfulness or yoga.

Call your midwife, doctor or hospital maternity unit if you have a very bad headache or a headache that won’t go away. This could be a symptom of pregnancy induced hypertension.  This is a type of high blood pressure that develops after 20 weeks and goes away within 6 weeks of the baby's birth. It’s also known as gestational high blood pressure or gestational hypertension.

Call your midwife, doctor or hospital straight away if you have a headache and vision problems and sudden swelling on your hands, feet, face or stomach. This could be a sign of pre-eclampsia, a pregnancy condition that can be dangerous for you and the baby if it is not monitored and treated. 

Call your midwife, doctor or hospital maternity unit if you have a headache and any of the following symptoms:

• discomfort in the lowest part of your stomach (pelvis)
• back pain
• loin pain (your sides between the lower ribs and pelvis, and the lower part of the back)
• needing to wee a lot or an uncontrollable need to wee
• cloudy, foul-smelling (fishy) or bloody wee
• a raised temperature  (over 37. 5°C)
• feeling sick (nausea) and vomiting.

This could be a sign of a urinary tract infection. UTIs cab be treated with antibiotics that are safe to use in pregnancy.

Migraines in pregnancy

Migraines are a common type of headache. Many people who have migraines may have:

• severe pain, which feels like a throbbing, pounding or pulsating pain
• nausea (feeling sick)
• pain brought on by bright lights
• an ‘aura’, such as flashing lights before the migraine starts.

 Talk to your doctor or midwife if you’ve had migraines before and if you are taking or have taken any medication for them. This is because some migraine medications can contain codeine, aspirin or ibuprofen, which are not recommended in pregnancy unless prescribed by a doctor and the benefits outweigh the risks.

Don’t wait until you have an attack. Your doctor should be able to give you advice on how you can manage your symptoms while you’re pregnant and if you choose to breastfeed.
 

Women with migraines are at slightly higher risk of developing high blood pressure and pre-eclampsia. This risk is very small and most women with migraines will not have high blood pressure.

If you have any worries at any time, talk to your midwife.

If you’ve never had a migraine call your midwife, doctor or hospital maternity unit. Serious conditions like pre-eclampsia can be like a migraine, so although it’s unlikely anything is wrong, your healthcare team may want to see you.

If you have always had migraines, you may find that they get better during your pregnancy. But pregnancy can also change the nature of migraines, so if you have a migraine that feels different to what you’ve had before, call your midwife, doctor or hospital maternity unit. 

One of the best ways to prevent migraines is to recognize what triggers an attack and trying to avoid them. For example, stress, eating certain foods or lack of sleep may bring on an attack.

Avoiding your triggers can be difficult when you’re pregnant. For example, if you have morning sickness you may not feel like eating or drinking much. This can cause low blood sugar or dehydration, so it’s important to try and find ways to cope.

Getting enough sleep may also be difficult during pregnancy. Try our tips for a better night’s sleep.

You should also try to

• drink at least eight glasses of fluid a day to avoid dehydration
• eat a healthy, balanced diet
• rest and relax as much as possible. You could try things like mindfulness or yoga.

You could also try acupuncture, which has been recommended by NICE as helpful for people with migraines. Acupuncture is a type of complementary therapy that involves a practitioner inserting thin needles at particular points on your body. It’s used to control and relieve pain.  Research has shown that it can also help with back pain  for pregnant women.

Acupuncture is generally safe to have when you’re pregnant but talk to your midwife or GP before you book a session. If you do want to try it, make sure your acupuncturist is fully qualified and that they use disposable needles at every treatment session. Tell your practitioner that you’re pregnant because certain acupuncture points can’t be used safely in pregnancy. 

Migraine Action

Migraine Trust

Migraine during pregnancy: what to do

Migraine is a benign disease, it does not affect the course of pregnancy and fetal development. However, migraine and pregnancy is a combination that requires a responsible attitude. Especially with frequent migraines (more than 2 times a week) and migraines with aura, because:

• medicines approved for use, few,

• and the approach to the treatment and prevention of migraine during this period is extremely individual: it depends on the frequency, severity and duration of headache, the degree of impact on life.

Our neurologist Daria Korobkova conducted a live broadcast on the clinic's Instagram account, where she told how migraine and pregnancy are connected, why attacks become more frequent or disappear, and answered subscribers' questions. The ether was saved, see “Air recording: migraine during pregnancy and GV.

We will tell about migraine during breastfeeding separately.

The statistics of clinical observations of migraine during pregnancy looks like this:

In 60-70% of pregnant women with migraine, headache attacks become less frequent, milder, or even completely disappear in the second and third trimesters. This is due to the stabilization of estrogen levels. By the beginning of the second trimester, it rises 6 times and its fluctuations stop.

In other women, migraine during pregnancy either remains unchanged or worsens. But as the duration of pregnancy increases, the proportion of such women gradually decreases:

If at the end of the first trimester the frequency and intensity of attacks persist, then it is most likely that migraine will disturb the woman throughout the entire period of pregnancy and after childbirth too.

How to manage migraine during pregnancy?

The main thing here is to learn how to control seizures and, if necessary, seek medical help.

1. Follow lifestyle advice:

• get enough sleep;

• drink enough fluids;

• eat fractionally and without long breaks;

• rest;

• avoid stressful situations. This is one of the main provocateurs of migraine. Psychotherapy, relaxation and stress management are here to help you.

2. Keep a headache diary. This will help you take control of migraine triggers.

Yes, these simple recommendations are sometimes enough to make seizures less frequent! Pregnancy is a special state of a woman. If in other periods of life we ​​do not take such recommendations so seriously, then in this situation it is worth trying to change the philosophy of life and attitude towards ourselves =)

How to relieve an attack?

1. Favor non-drug methods. Sometimes, in order to relieve an attack, it is enough to eliminate an unfavorable factor:

• dry biscuits, ginger, or applesauce may help with nausea;

• for dehydration - diluted juice or other liquid;

• sleep, walking or breathing exercises can also help to cope;

2. If the attacks are severe, interfere with your life, then under the supervision of a specialist, you can resort to drug therapy.

PARACETAMOL is considered the safest and can be taken throughout pregnancy.

All other drugs have nuances. For example:

• ibuprofen can be taken in the second trimester, and in the first trimester it is better to limit, in the third trimester the drug is contraindicated for use;

• aspirin is prohibited in the 3rd trimester and is undesirable for taking in the first two, as it can cause extremely undesirable consequences;

• It is strictly forbidden to use ergotamine and opioid analgesics;

• triptans are not officially approved for use during pregnancy as no controlled studies have been conducted. However, clinical observations of women around the world who took them on their own showed no adverse effects on the fetus. We discussed this issue in more detail on the air.

!Other than paracetamol, we do not recommend the use of any drug without a doctor's prescription.

When to see a doctor:

• migraine occurred for the first time during pregnancy;

• if migraine attacks suddenly become more frequent and stronger;

• if the aura became longer or appeared for the first time;

• if the headache is rapidly increasing and has an unusual character;

• if the pressure rises during the headache.

Follow our Instagram to read the latest materials on the diagnosis and treatment of headaches!

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

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When to call an ambulance

Call 103 or 112 urgently if you experience the following symptoms:

• sudden and severe headache;
• consciousness becomes confused or completely lost;
• 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;
• the muscles of the neck are very stiff, it is impossible to reach the chest with the chin;
• temperature rises to 39 °C or more;
• increased heart rate at rest;
• severe shortness of breath;
• the child pushes without stopping or stops abruptly;
• leaking water or blood;
• pain in the lower abdomen, 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 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 develops a 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.

What to do

Tension headache can go away on its own: just get some fresh air or sleep. Sometimes pleasant emotions help, which distract from experiences.

If the pain persists for 2-3 consecutive days, see a doctor. He will select painkillers that are safe for the child.

2. Taking medications

Any medication that enters the stomach or blood can cause headaches even if the dosage is correct. In pregnant women, this often occurs due to drugs for high blood pressure, heart disease, antibiotics, anticonvulsants.

Long-term use of non-steroidal anti-inflammatory drugs for headaches may cause the opposite effect: the pills do not remove, but provoke symptoms.

What to do

If your head hurts a few hours after taking the medicine, you need to see a doctor to change the medicine. Do not drink non-steroidal anti-inflammatory drugs for more than 3-5 days. If they do not help, you need to tell the doctor about it.

3. Love or refusal to coffee

Coffee can cause headaches during pregnancy. Unpleasant symptoms occur if you drink more than 3-4 cups a day.

Abrupt refusal of coffee is also harmful. It is worth finding out about pregnancy and stopping brewing a fragrant drink, and after 1-2 days, aching pain will appear in the temples and the back of the head.

What to do

Coffee is best avoided during pregnancy. If a headache occurs a day after this, you can drink a small cup of the drink and wait a day again. Gradually, the dependence on coffee will pass.

Coffee drinkers can reduce their drink intake to 1-2 cups per day.

4. Infection with fever

Acute viral (usually SARS) or bacterial (eg, streptococcal tonsillitis) infections cause fever and headache. This is a normal reaction to foreign microorganisms.

But any infection is dangerous for pregnant women. It can cause fetal defects, growth retardation and even miscarriage. And with meningitis, especially listeriosis, there is a threat to the life of the mother.

What to do

If you have a headache with fever, call your doctor. He will prescribe safe medications or give you a referral to the hospital if a serious infection is suspected. In this case, you need strong antibiotics, droppers to maintain the body and sometimes hormones.

5. Preeclampsia and preeclampsia

After 20 weeks, preeclampsia may develop in pregnant women. This is a disease in which one of three symptoms or a combination of them may appear: high blood pressure, edema, and protein in the urine.

Without proper treatment, preeclampsia turns into preeclampsia. The pressure rises sharply, the head and lower abdomen hurt unbearably, the baby pushes unusually hard or, on the contrary, suddenly calms down. Preeclampsia can lead to placental abruption, damage to the liver and other organs, bleeding, and even seizures. Without urgent medical care, the fetus and mother die.

What to do

When the first signs of preeclampsia appear, the pregnant woman is hospitalized to find treatment. After that, she is discharged home under the supervision of her gynecologist.

But if her health worsens, the doctor again sends the woman to the hospital, where she is prescribed medicines to reduce pressure, special droppers to keep her body functioning. If improvement does not occur within a day, a caesarean section is performed.

6. Migraine

One of the causes of migraine is a change in estrogen levels. But the disease very rarely appears due to pregnancy. On the contrary, in 70% of women, the symptoms subside dramatically after conception. Nevertheless, migraines torment many.

It may begin with an aura: flashes of light, spots before the eyes, tingling in the hands or numbness of half of the face, sometimes tinnitus. Each symptom can last from 20 minutes to an hour.

A migraine attack develops after the aura. In this case, one side of the head hurts and throbs, nausea or vomiting appears. A woman is irritated by bright lights, loud noises, smells. They make the pain worse.

Seizures last from a few hours to a week or more. After a migraine, there is a feeling of severe fatigue, exhaustion, and an awkward turn of the head can return the pain.

What to do

Any medication for migraine during pregnancy must be prescribed by a doctor. In some cases, drugs from the group of beta-blockers are used.

Studies have shown that frequent migraine in pregnancy is associated with a lack of magnesium. The doctor will help you choose the appropriate type of vitamin and mineral complex and its dosage.

7. Cerebral vascular disease

Hormone problems in some pregnant women increase blood clotting, which increases the risk of thrombosis, stroke, or bleeding in the meninges. These conditions are very dangerous: a woman can die within a few minutes or remain disabled.

Vascular involvement is always accompanied by several symptoms:

• severe headache on one side;
• nausea and vomiting;
• blurred vision;
• loss of consciousness;
• convulsions.

What to do

Urgently call an ambulance. The pregnant woman must be laid or seated so that she does not hit when she falls. You can't give medicine! You can only open the window so that there is more air in the room.

Which treatment the doctor prescribes depends on the specific disease. These can be drugs that reduce blood clotting and dissolve blood clots. In some cases, urgent surgery is needed.

8. Brain tumors

Studies show that progesterone and estrogens during pregnancy can trigger or accelerate the growth of tumors in the brain. Symptoms of the disease appear slowly, over several months, and depend on the size and location of the tumor.

The headache may gradually increase, then vision, speech, hearing deteriorate, limbs go numb and convulsions appear. Sometimes it is difficult for a woman to keep her balance.

What to do

If a pregnant woman often has a headache or she forgets what she wanted to buy in the store and how to cook her favorite borscht, confuses her way home, you need to go to a neurologist. First, he will prescribe standard treatment, simple and safe medicines, rest, good sleep.

If this does not help, the symptoms persist or worsen, a deep examination is needed. The pregnant woman will be sent for an MRI of the brain. This procedure is safe for the fetus. If the diagnosis is confirmed, surgery may be required.

What to do if the doctor cannot find the cause of the pain

If you have been examined and the doctor cannot tell you why your head hurts and diagnoses you with vascular dystonia, this is a reason to be wary. There is no such disease.

Look for another doctor. Perhaps he uses new diagnostic methods that will help to deal with the problem and choose a treatment.

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