Are Headaches Normal During Pregnancy?
If you're pregnant, you're no doubt having new aches and pains. It's normal to get headaches, including migraines, during pregnancy – they don't affect your baby but can be unpleasant for you.
What Causes Headaches During Pregnancy?
Many things can trigger a headache during pregnancy, including:
- A change in your hormone levels and blood volume
- Stress
- Fatigue
- Eyestrain
- Sinus problems, which are more common early in your pregnancy
- Low blood sugar levels
- Caffeine withdrawal
- Dehydration from vomiting
Exactly what causes migraine headaches isn't known. But migraines appear to involve changes in nerve pathways, neurochemicals, and blood flow in the brain.
Researchers believe that overly excited brain cells stimulate a release of chemicals. These chemicals irritate blood vessels on the brain's surface. That, in turn, causes blood vessels to swell and stimulate the pain response.
Experts think estrogen plays a role in migraines. That's why pregnancy, menstruation, and menopause often change a woman's pattern of migraine headaches.
The neurotransmitter serotonin also appears to have a key role in migraines.
Tracking Triggers With a Headache Diary
Hormone changes during pregnancy are not the only thing that can trigger headaches. Most women have a combination of triggers. And something that triggers a headache one day may not bother you at all the next.
Some headaches last a few hours. Others, like migraines, could last a couple of days if left untreated. Migraines are quite unpredictable. So, while pregnancy may make them worse for one woman, they might completely disappear for another.
A headache diary can let you track your particular triggers. This will help your doctor decide on what treatment will work best to relieve your specific symptoms. It may also help you recognize a pattern that tells you which triggers to avoid while you're pregnant.
Each time you have a headache, write down:
- Your specific symptoms: where you feel the pain, what the pain feels like, and any other symptoms such as vomiting or sensitivity to noise, smells, or bright light
- The time your headache started and ended
- Foods and beverages you had during the 24 hours before the migraine
- Any change in your environment, such as traveling to a new place, a change in the weather, or trying new kinds of food
- Any treatment you tried, and whether it helped or made the headache worse
Common headache triggers include:
Diagnosing Pregnancy Headaches
A pregnancy complication called preeclampsia can cause headaches. So your doctor may check you for that condition before diagnosing migraine. Tell your doctor about all your medications, including over-the-counter products and natural supplements. Also, let them know whether anyone in your family has had migraines.
Your doctor can often diagnose migraines from a headache diary and your medical history. CT scans and other radiology tests to rule out other causes of your headaches aren't usually advised in pregnancy. That's because of the potential risks to your baby.
Natural Ways to Get Rid of Headaches While Pregnant
Your first line of defense against headaches is a healthy lifestyle and self-care. Here are some tips to help you manage headaches during pregnancy:
- Avoid your known triggers, such as specific foods and allergens, as much as possible.
- Keep a predictable schedule of meals and snacks.
- Drink plenty of water.
- Get plenty of rest.
- Consider taking a class in biofeedback or other relaxation techniques.
- When pain strikes, try ice packs, massage, and resting in a quiet, darkened room.
- Avoid smoking and secondhand smoke.
Headache Medicines During Pregnancy
Acetaminophen is the usual choice of painkiller during pregnancy, but it's best to take the least amount possible for the shortest amount of time. Talk to your doctor about how much is safe and the length of time. Avoid painkillers with codeine, as well as NSAIDs like ibuprofen, unless your doctor says they're OK to take.
Many of the anti-migraine medications to treat or prevent migraine headaches and their symptoms should be avoided during pregnancy. Some have been linked to birth defects in babies. Other medications are linked to pregnancy complications. For instance, some have been linked to bleeding, miscarriage, or intrauterine growth restriction (IUGR), a condition in which the uterus and fetus don't grow normally.
Treatments for Acute Headaches During Pregnancy
Acute treatment aims to stop a headache after its first signs appear.
Pain relievers, also called analgesics, may help ease the intense pain of headaches. These general pain-relieving drugs, though, aren't specific to the migraine pain pathway:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may carry a risk of bleeding and miscarriage if taken in early pregnancy. There is also a possible risk of heart complications in the baby if they are taken in the third trimester. Aspirin taken near delivery may lead to excess blood loss in mothers during birth.
- Most NSAIDs, including ibuprofen – sold over the counter under the brand names Advil and Motrin – and naproxen – sold as Aleve, Naprosyn, and other brands – don't have enough controlled human research studies to assess all their risks in pregnancy.
- Narcotic pain relievers should generally be avoided. There is a risk of addiction and medication overuse headaches as well as chronic daily headaches. If necessary, your doctor will prescribe the lowest dose possible for the shortest time needed to control your pain.
- Triptans work specifically on the migraine pain pathway. Triptans aren't known to cause birth defects. But most research to date has focused on animals, not humans. Your doctor can help you decide if it is safe for you and your unborn baby.
Ergotamines work specifically for migraine pain. But doctors advise against taking these drugs during pregnancy. They carry a risk of birth defects, especially if taken in the first trimester. These drugs may also stimulate labor contractions and premature birth.
Other medications may be prescribed for relief of specific symptoms of migraine during pregnancy. For instance, antiemetics help soothe the vomiting and nausea that can come with migraine. But many of the drugs typically used for migraine haven't been adequately studied in pregnancy, so we don't yet know about their safety or risk to the fetus.
Preventive migraine treatment
If you have severe, recurring attacks, preventive treatment may stop future attacks or make them less severe. Many of the drugs used for prevention were first used for other conditions, such as high blood pressure.
See a neurologist who has treated pregnant people. They'll prescribe medicine in the lowest dose needed to help you and likely suggest other non-medication therapies. Relatively safe medications for migraines include high blood pressure medicines like beta-blockers, such as metoprolol (Lopressor, Toprol XL) and propranolol (Inderal LA, Inderal XL, InnoPran XL), and calcium channel blockers like verapamil.
When you're pregnant, always talk with your doctor before taking any drug, herbal product, or natural medicine.
If you can't take medications or wish not to, you might consider a device. Cefaly is a portable headband-like device that gives electrical impulses to the skin at the forehead. This stimulates a nerve linked to migraine headaches. Cefaly is used once daily for 20 minutes; when it's on, you'll feel a tingling or massaging sensation.
SpringTMS is a magnet placed on the back of the head at the first sign of a headache. It gives off a split-second magnetic pulse that stimulates part of the brain. It usually has no side effects. Also, gammaCore is a hand-held portable device that is a noninvasive vagus nerve stimulator (nVS). When placed over the vagus nerve in the neck, it releases mild electrical stimulation to the nerve's fibers to relieve pain.
If you see a headache specialist, double-check with your obstetrician or certified midwife about the safety of any medications or devices during pregnancy. While migraine pain may be severe, taking a risk with your baby's health could cause lifelong health problems for your child.
When to Contact Your Doctor
Contact your doctor for any of these headache-related symptoms:
- A severe headache
- An ongoing headache
- Dizziness or vision changes
Symptoms of preeclampsia call for a visit to the doctor. They include:
- A severe headache
- Vision problems
- Pain below your ribs
- Throwing up
- Sudden swelling in your face, hands, feet, or ankles
Takeaways
Headaches, including migraines, are common during pregnancy due to things like hormonal changes, stress, fatigue, or dehydration. While unpleasant, they don’t harm your baby and often improve as pregnancy progresses. Keeping a headache diary can help identify triggers such as certain foods, caffeine withdrawal, or low blood sugar. To manage headaches, focus on self-care by staying hydrated, eating regularly, resting, and avoiding known triggers. Safe treatments like acetaminophen can help, but consult your doctor before taking medications.
