We have all heard of morning sickness, exhaustion, breast tenderness and other discomforts resulting from pregnancy. But pregnancy headaches? They are more common than you think (they tend to occur primarily during the first and third trimesters), caused by everything from a surge in hormones and changes in posture to caffeine withdrawal and tension.
Unfortunately, just like with acid reflux, hemorrhoids and diabetes, a pregnant woman may have rarely had a sign of a headache prior to pregnancy and then suddenly she is suffering from them regularly. “For some women, the headaches stay the same, but for others they may improve or worsen,” says Dr. Lauren Demosthenes, senior medical director with Babyscripts.
And while pregnancy headaches aren’t that uncommon (they tend to occur primarily during the first and third trimesters), treating them can be a lot trickier than you’d think.
How to treat headaches in pregnancy.
The general approach to managing pregnancy headaches is to try to recognize triggers and avoid those in the first place. “With changes in hormones and blood volume, your body may be more sensitive, so try to be very scheduled with hydration, rest, eating and relaxing,” says Dr. Demosthenes. “This may be hard for shift workers and women with an erratic schedule, but do the best that you can – ask permission to drink fluids during work and to keep snacks available. If these lifestyle modifications do not help, then the medication approach starts with Tylenol 1000 mg.” If that doesn’t work, Dr. Demosthenes recommends trying aspirin or medications like ibuprofen, but these should be avoided in the first trimester and after 20 weeks of pregnancy due to the small chance of birth defects. “Possible harm to the fetus includes premature closure of an important cardiac vessel and effects on the baby’s kidney system.”
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Dr. Demosthenes goes on to note that some women have found relief with caffeine with little risk to the fetus if caffeine levels are kept at below 200 mg/day. “Triptans (sumatriptan) can also be used for moderate to severe migraines if Tylenol and rest don’t help. Studies have been reassuring that this class of drug doesn’t cause birth defects, miscarriage or prematurity.”
In extreme cases of headache, opioids can be used, but Dr. Demosthenes cautions that there’s a potential of addiction for the mom and then potential neonatal withdrawal in those women. “We are very cautious about prescribing those. If they are needed, take care to take the lowest dose for the shortest time possible.”
When headaches become worrisome.
Tension, cluster and simple migraine headaches are not worrisome in pregnancy, but occasionally, headaches can be an indication of a serious complication like preeclampsia, in which dangerously high blood pressure puts mom and Baby in jeopardy.
“All women 20 weeks pregnant or more with a new onset headache that is not relieved by Tylenol should be evaluated for pre-eclampsia,” says Dr. Demosthenes. “Preeclampsia is a hypertensive disease of pregnancy that can have tragic effects on both mom and baby if left unattended. Preeclampsia headache is usually diffuse, constant, throbbing and mild to severe in intensity. It’s often accompanied by blurred vision or seeing ‘flashing lights’ and by an increase in blood pressure.”
What happens postpartum?
A headache after delivery in women who had a spinal or epidural anesthetic may indicate a ‘spinal headache.’ “This headache generally develops within 48 hours of the procedure and is worse with standing and sitting. It’s usually relieved by lying flat,” says Dr. Demosthenes. “Beyond that, the time after childbirth is one of hormone changes, sleep deprivation, irregular meals, stress and fatigue… it’s no surprise that headaches also occur/and or continue in the postpartum,” says Dr. Demosthenes. “In addition to doing your best to optimize your schedule, you can now add in Advil to treat your headache. Advil is safe in breastfeeding mothers.”
