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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 the following symptoms appear:

• 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. Medications

Any medication that enters the stomach or bloodstream 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 for coffee or rejection of it

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 ARVI) 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 medication to reduce pressure, special drips 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 cause for concern. There is no such disease.

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

How to avoid pregnancy headaches

Experts recommend:

• Avoid triggers. For example, if you notice that certain foods, smells, or situations cause headaches, try not to encounter them.
• Protect yourself from stress, do not worry about trifles.
• Move more. During pregnancy, walk every day in the fresh air and do special exercises for expectant mothers.
• Eat right. Try to eat a lot of vegetables and fruits, dairy products, drink at least 2.4 liters of liquid. Every day, the menu should include fish, poultry or lean meat. And it is better not to buy sweet, fast food and other junk food.
• Follow the daily routine. You need to sleep at least 8 hours a day and go to bed no later than 22-23 hours in order for melatonin to be produced normally.
• Learn to relax. Learn simple meditation techniques or breathing exercises.

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Pregnancy headache

Authors: A. Yu. Limanskaya, Yu.V. Davydova

19.01.2017

A.Yu. Limanskaya

Tension headache and migraine are the most common types of headache (30-78% and 15% respectively). According to the WHO, primary headache is in general in 10th place among all conditions leading to disability, and in women, in 5th place. In 16% of patients, episodic tension-type headache becomes chronic. The economic loss in Western Europe and North America due to headache-related disability is estimated at $17-20 billion a year. To date, there is a trend towards an increase in the incidence of headache in young people.

Yu.V. Davydova

The International Headache Society defines migraine as a throbbing, unilateral headache associated with nausea, sensitivity to light, sound, and turning of the head.

In a broader sense, this pathology can be considered as a hereditary disease in which physiological changes (whether external, such as changes in weather conditions, or internal, such as changes in sleep patterns) often cause stereotypical attacks with migraine symptoms, as defined above. Migraine occurs three times more often in women than in men, with the highest rates in women during active childbearing age, peaking at 27% at age 41 years. To date, there is no evidence that migraine itself affects fertility or the course of pregnancy, but the quality of life in pregnant women with migraine is significantly reduced.

According to some researchers, migraine and tension-type headache in pregnant women are risk factors for the development of arterial hypertension and preterm birth (F. Facchinetti et al., 2009). Pregnancy can provoke the occurrence of diseases accompanied by headache (preeclampsia, thrombosis of the cerebral arteries, compression of the brain as a result of the presence of tumors). Relevant today is the rapid diagnosis of pathology and an adequate choice of therapeutic and obstetric tactics for the treatment of headaches in pregnant women due to the great medical and social significance of the problem.

Antiphospholipid syndrome (APS) is defined by the presence of antiphospholipid antibodies (APLA) associated with an increased risk of thrombosis or recurrent spontaneous abortions. The most serious complications can occur in secondary APS against the background of inflammatory systemic autoimmune diseases. Studies conducted in neurological clinics have found that it is migraine, and not headache of all types, that is significantly associated with APLA in patients with systemic autoimmune pathology. However, in patients with systemic lupus erythematosus (SLE), headache is significantly associated with positive APLA titers. Also in this group, cerebral ischemic lesions were significantly more common.

During pregnancy, a woman may experience many health problems. For example, a headache during pregnancy occurs quite often, at different times of the day and for various reasons. Oddly enough, but a woman's frequent headache may be a sign of pregnancy, which she does not yet know about.

More than 80% of women sooner or later complain of a headache during pregnancy. Even if a woman was absolutely healthy before pregnancy, then during the bearing of a child she gets a headache. Sometimes it becomes so strong that it is difficult to endure. Headache can occur at any time during pregnancy, but it tends to be most common during the first and third trimesters.

There are factors that can cause headaches during pregnancy.

1. Hormonal changes: The state of the nervous system depends on the woman's hormonal status, that is, on the quantity and quality of hormones produced.

2. Hypotension during pregnancy is associated with the predominance of progesterone over other hormones; the vasodilating effect of progesterone leads to a decrease in blood pressure, cerebral hypoxia and, as a result, to headache.

3. Arterial hypertension and preeclampsia cause headache as a result of generalized vasospasm and circulatory disorders in the central nervous system.

4. Nutritional factors - cold food or eating foods containing tyramine and phenylamine (nitrogen compounds that can affect blood vessels) can cause headache attacks; pregnant women who are prone to migraine headache should be careful in consuming the following foods: chocolate, nuts, yogurt, chicken liver, avocados, citrus fruits, bananas, canned and pickled foods, Japanese cuisine, tea, coffee, cola, sausages, red wine, cheese.

5. Hunger headache occurs as a result of a decrease in blood glucose levels and impaired supply of nutrients to the brain.

6. Overweight.

7. Eye strain or prolonged forced stay in the same uncomfortable position.

8. Allergic reactions.

9. Dehydration of the body.

10. Exacerbation of chronic diseases - spine, especially osteochondrosis, due to increased load during pregnancy, static and dynamic loads often cause headaches; neurocirculatory asthenia as a cause of vasospasm and as a consequence of the appearance of a feeling of heaviness in the head, mood lability and headache.

11. Occurrence of infectious and other diseases such as: meningitis, encephalitis, sinusitis, pyelonephritis, glomerulonephritis and certain ophthalmic pathologies; the characteristic manifestations of this headache are its intensity and the lack of effect of pain medications.

12. Stress factor. Lability of the nervous system, ups and downs in mood, excitement, psycho-emotional stress, depression - all this can cause a headache.

13. Changing weather conditions. During pregnancy, fluctuations in atmospheric pressure can lead to headaches.

14. Physical irritants – flickering light, noise, strong smells.

15. Weekend headache. If you sleep longer than usual during the day, the cause of headache can be, for example, venous congestion.

16. Indoor climate: too dry or warm air, a lot of tobacco smoke.

The most common form of headache during pregnancy is migraine, which is accompanied by visual impairment, gastrointestinal disorders, nausea, vomiting, photoreaction, and various vestibular disorders.

In the United States, 28 million people aged 12 and older suffer from migraine, of which 21 million are women aged 25-55. In about 25% of families, one of its members suffers from migraine.

A feature of migraine pain is known to be severe, throbbing pain, predominantly hemicrania, often preceded by aura and marked photoreaction.

It is noteworthy that about 15% of women who have never experienced migraine before, first encounter it with the onset of pregnancy. On the other hand, there are cases when during pregnancy a woman completely stops migraine attacks. In this case, this is due to changes in hormonal status and the absence of ovulation and menstruation.

The occurrence of migraine in women under the influence of hormonal changes is possible throughout the entire menstrual cycle. The positive effect of pregnancy on migraine is observed in 55-90% of women during the gestation period, regardless of the type of migraine. The relief of headache symptoms during pregnancy and their possible worsening after childbirth is likely due to uniformly high and stable estrogen levels during pregnancy and their rapid decline after childbirth.

Another type of headache in pregnancy is tension headache. As a rule, it is characterized by medium intensity, unlike migraine, it often covers the entire head. The pain of tension squeezes the head like a hoop, or causes a pulling sensation; occurs mainly as a result of stress or overexertion.

- If a woman has frequent headaches before pregnancy, the risk of developing preeclampsia increases by 2. 4 times
- If a woman is diagnosed with migraine before pregnancy, the risk of developing preeclampsia increases by 3.5 times migraine attacks are observed in the early stages - the risk of developing preeclampsia increases 4 times

Pregnancy headache treatment
A pregnant woman needs medical advice if:

• headache has become almost constant, and has recently changed its character;
• headache in the morning and all day;
• pain is permanently localized in a certain area of ​​the head;
• headache is accompanied by other symptoms - impaired vision, hearing, speech, motor functions, sensitivity, etc.;
• Pain accompanies high or low blood pressure.

Doctor's prescriptions depend on the underlying cause of the headache. Sometimes several factors influence at once, so it is difficult to make an accurate diagnosis. If the headache bothers you regularly, you should contact a neurologist for a specific examination.

Primary therapy during pregnancy - non-drug (relaxation, sleep, massage). For the treatment of acute migraine attacks, paracetamol (1000 mg) is considered the drug of choice, preferably in the form of suppositories. The table shows data on the possibility of using a number of drugs for the treatment of headache during pregnancy.

The risks associated with the use of aspirin (acetylsalicylic acid) and ibuprofen are considered relatively low if the drugs are taken episodically and removed in the last trimester.

Information on the safety of triptan treatment during pregnancy is available for only a few drugs in this group (sumatriptan, naratriptan and rizatriptan). According to information databases containing information on pregnancy outcomes in women who received these drugs, there were no facts indicating serious risks to the mother and fetus.

With some triptans (sumatriptan, zolmitriptan, naratriptan), there is currently a possibility of a small increase in preterm birth, so triptans are acceptable in severe migraine in exceptional cases. However, data on the use of triptans continues to accumulate and there is not yet sufficient evidence for the safety of the use of triptans during pregnancy.

Dihydroergotamine and ergotamine tartrate are contraindicated in pregnant women.
Headache definitely cannot be tolerated, it must be correctly diagnosed, differentiated and treated.

The American Academy of Neurology recommends a brain scan in the following cases (if pregnant, only MRI is recommended)

- if, in the presence of a headache, a neurological deficit occurs or any, even short-term, changes in the neurological status;
- if the headache has atypical manifestations and does not fit into the strict framework of establishing a diagnosis of migraine;
- if there is a proven immunodeficiency;
- a sudden severe headache in women for the first time.

• Number:
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