Headache

What is a headache?

There are 3 types of headaches that are commonly seen during pregnancy which are tension headache, migraine, and cluster headache. Most women will have suffered from headaches prior to getting pregnant but about 10% of women will first experience headaches while they are pregnant.

The symptoms of a headache are not any different during pregnancy. Tension-type headache is the most common headache and typically feels like pressure on either one or both sides of the head. They tend to occur in a band-like pattern from the forehead to the back of the head and may be felt down into the neck. The headache can last anywhere from 30 minutes to several days.

A migraine is almost always felt on one side of the head and feels like a pulsing or throbbing pain. Women with migraines will frequently have other symptoms that come with the headache like nausea, vomiting, and sensitivity to light or sound. Some women may get auras, as much as, an hour before the headache even begins. Auroras may include visual changes (like blind spots or bright flashing lights), numbness, weakness, or problems talking.

Cluster headaches are not seen as often as tension headaches or migraines. They are usually felt in the temple or in the eye area and frequently are associated with at least one other symptom in the eye, nose, or face area. Nasal congestion on the same side as the headache is the most common of these other symptoms. These headaches tend to occur at the same time every day for weeks to months, hence the name cluster.

How common are headaches during pregnancy?

Headaches are very common in women, with one study reporting 60% of women saying they had a headache within the last year. Tension headaches are the most common type of headache, with up to 40% of all adults experiencing them. Women tend to get tension headaches slightly more often than men. Migraines are the second most common type of headache and affect approximately 18% of women. Cluster headache is the least common in women.

As many as 60 to 70% of women who have migraines prior to pregnancy will notice a decrease in the severity and frequency of their headaches. Five percent of women will notice their headaches get worse and the remaining women will notice no differences in their migraines. Women who have tension or cluster headaches dont tend to notice any difference in the frequency or severity of their headaches while they are pregnant.

How is a headache diagnosed during pregnancy?

Headaches are diagnosed the same in pregnant women as they are in non-pregnant women. Most headaches can be diagnosed solely by the description of the headache the person gives and any symptoms that occur with the headache. If you had headaches before you got pregnant and the headaches you are experiencing in pregnancy feel the same, then no additional testing needs to be done before treating the headache. However, if you did not have headaches before you got pregnant or if your headaches are suddenly different than before, you should talk with your health care provider. If the new headaches are starting after you are 20 weeks pregnant, you may need to be checked for preeclampsia, since headaches can be a sign of this. The first check for preeclampsia is a blood pressure check and if it is abnormal, then lab tests may need to be done.

Do headaches cause problems during pregnancy?

Headaches do not seem to cause any problems for the pregnancy.

Do headaches during pregnancy cause problems for the baby?

Headaches do not seem to cause any problems for the developing baby.

What to consider about taking medications when you are pregnant or breastfeeding:

You should think about:

• The risks to yourself and your baby, if any, if you do not treat the headache
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat a headache during pregnancy?

Migraine, tension headache, and cluster headache may be uncomfortable but they wont cause any serious problems for the pregnancy or the developing baby. Therefore, taking medicine for the headache may not always be needed. Trying one of the alternative treatments discussed below should be considered first to treat your headache. Eating regular meals, sleeping regularly, and avoiding headache triggers can be helpful in preventing a headache from occurring. If the headache is bad enough to need medicine, it is usually recommended to take acetaminophen first but this should be discussed with your health care provider before you take it.

Who should NOT stop taking medication for a headache during pregnancy?

Stopping headache medication will not cause harm to your health, or the health of your developing baby and for many medications is recommended. However, some daily preventative treatment may need to have the dosage slowly decreased before stopping it to prevent any withdrawal symptoms. If you are taking a daily preventative treatment, it is best to discuss stopping it with your health care provider rather than just stopping it on your own. Depending on the type of headache you have, you may find that your headaches improve enough that medication is not needed or that one of the alternative treatments discussed below helps relieve your headache.

What should I know about choosing a medication for my headache during pregnancy?

Tension headache:

It is usually recommended to try acetaminophen (Tylenol) for tension headaches and to avoid NSAIDs (i.e. ibuprofen, naproxen) or aspirin. Pregnancy data shows that, when used as directed, short term use of acetaminophen during all trimesters is safe.

Caffeine may also be tried along with acetaminophen but it is important to limit daily caffeine intake during pregnancy to less than 200 mg, as recommended by the American College of Obstetricians and Gynecologists. Keep in mind that caffeine is found in coffee, tea, soda, and chocolate so these things must be avoided if taking a medication with caffeine in it for your headache.

Butalbital and codeine (combined as Fiorect) may also be used as combination therapy to treat tension headache. However, both of these should be used sparingly because regular use can end up causing worse headaches and use during the third trimester can cause withdrawal symptoms in your newborn baby. Also, it is recommended to avoid codeine use during the first 13 weeks of pregnancy because it has been associated with some types of birth defects.

Migraine:

The initial treatment of migraines is similar to tension headaches. Since nausea is frequently associated with migraines, metoclopramide (Reglan) is commonly used with acetaminophen to improve symptoms. This is safe to use throughout the pregnancy.

Triptans are the most common treatment for migraines in non-pregnant women but there isnt a lot of safety information about these medications in pregnancy. They are generally avoided during pregnancy.

Opiates, like Percocet and Vicodin, can be used for migraines if they dont improve with other treatments. However, both of these should be used sparingly because regular use can end up causing worse headaches and use during the third trimester can cause withdrawal symptoms in your newborn baby.

The class of medications called ergotamines, which include Migranal, Cafergot, and Migergot, should always be avoided while you are pregnant because they can cause miscarriage, preterm labor (labor before 37 weeks), and problems with the babys growth.1

Cluster headache
:

Women with cluster headaches are usually treated with 100% oxygen and triptans however, triptans are usually avoided in pregnancy. Lidocaine placed inside the nose for 5 minutes appears to be a safe treatment for cluster headaches during pregnancy.3

As discussed above, ergotamines should not be used during pregnancy.

General Information:

For some women, headaches may be severe enough that the use of a medication that is generally recommended to avoid during pregnancy may be needed. If this is the case, you should always discuss all of the potential risks the medication may have, along with the potential benefits, with your health care provider.

You may find Pregistrys expert reports about the individual medications to treat this condition here. Additional information can also be found in the sources listed at the end of the report.

What should I know about taking a medication for my headache when I am breastfeeding?

Many of the medications used to treat headaches are considered safe to use while nursing despite the limited available information. Salicylates, like aspirin, should be used cautiously while nursing because they may cause bleeding problems in nursing infants. It is recommended not to use any of the ergotamines (Migranal, Cafergot, and Migergot) while breastfeeding because they have been found to cause vomiting, diarrhea, and seizures in nursing infants.

What alternative therapies besides medications can I use to treat my headache during pregnancy?

Alternative treatment for headaches should be tried before taking medicine during pregnancy. All of the following can be tried to relieve or prevent a headache:

• Avoid headache triggers like certain foods or odors
• Keep a regular sleep pattern
• Eat regular meals
• Find ways to manage stress, whenever possible
• Learn and practice relaxation techniques like yoga, meditation, massage
• Get regular, moderate exercise for at least 30 minutes per day
• Consider trying biofeedback, relaxation therapy, or psychotherapy
• Use a cold or warm compress on the head or back of your neck (choice depends on which your headache responds to)
• Acupuncture or acupressure
• Hydration

What can I do for myself and my baby when I have a headache during pregnancy?

The best thing to do for headaches during pregnancy or nursing is to try and treat the headache with one of the alternative therapies discussed above. While tension headache, migraine, and cluster headache can be very painful for many women, it is important to remember that they arent serious or lifet-threatening. However, if you have not previously had headaches, the headache is different from your normal headache, or the headache persists after trying treatment, you should call your health care provider.

Resources for headaches during pregnancy:

For more information about Anemia during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

• American Academy of Family Practice
• American Academy of Neurology
• The Migraine Trust