Recognizing Dangerous Headaches in Pregnancy

Headaches are common during pregnancy. While they're painful, they're usually nothing to worry about. However, headaches in pregnancy can sometimes be a warning sign of a more serious problem like preeclampsia—a condition that involves high blood pressure.

Here's what you need to know about the different types of headaches during pregnancy, how to recognize them, and what to do if you think your headache may be a sign of a dangerous complication.

Types of Headaches

Headaches are classified by what causes them and fall into two categories:

• Primary headaches, where the pain itself is the only problem
• Secondary headaches, where the pain is caused by another medical condition

About 40% of pregnant women report having headaches during pregnancy or postpartum (in the weeks after giving birth). Most are primary headaches and are less worrisome.

However, research suggests that secondary causes of headaches may be more common among pregnant women than was previously thought. One study found that between 25% and 42% of pregnant women seeking treatment had a secondary headache.

During the first trimester, nausea, vomiting, and dehydration due to morning sickness, hormonal causes, as well as low blood sugar and caffeine withdrawal, can trigger headaches.

During the second and third trimesters, triggers include poor posture, lack of sleep, high blood pressure, and diabetes.

Common types of headaches during pregnancy include:

• Tension headaches: Pain that feels like a tight band around your head, or pain in the neck and shoulders
• Migraines: Pain lasting hours, sometimes days, and may include blurred vision, light flashes, light sensitivity, nausea, and vomiting
• Sinus headaches: Pain or pressure around the forehead, cheeks and eyes, along with stuffy nose and congestion
• Cluster headaches: Pain usually around one eye or side of the head, wakes you up at night, and occurs in patterns
• Thunderclap headaches: Sudden, severe pain that peaks within a minute, lasts for at least five minutes, and can cause numbness and difficulty seeing, speaking, and walking

It's important to tell your healthcare provider about any headaches you experience during pregnancy.

Headache As a Preeclampsia Symptom

When a headache during pregnancy is accompanied by dizziness, blurred vision, or blind spots, it's time to call your obstetrician or healthcare provider.

These could be symptoms of serious complications, such as preeclampsia, a condition that usually occurs after the 20th week of pregnancy. Preeclampsia can damage organs like the liver or kidneys and lead to a low number of platelets, cells in the blood that are important in the clotting process.

One study found that pregnant women with high blood pressure and a headache were 17 times more likely to suffer severe complications, like preeclampsia.

Besides high blood pressure (hypertension), other signs and symptoms of preeclampsia include:

• Abdominal pain
• Protein in the urine
• Swelling, usually in the feet, legs, face, and hands
• Sudden weight gain
• Nausea and vomiting

Some people with preeclampsia develop a headache that resembles a migraine—a throbbing headache with nausea and/or a sensitivity to light or sound. This is another cue to contact your healthcare provider right away, especially if you don't normally get migraines or the pain is different, more intense, or longer lasting than the headaches you usually get.

If preeclampsia is suspected you will likely be sent to the hospital for further evaluation and treatment.

If you are determined to be at risk for preeclampsia early in your prenatal care, your healthcare provider may recommend that you take low-dose aspirin to help prevent preeclampsia and its related complications. This is usually started between 12 to 28 weeks, but ideally before 16 weeks.

Left untreated, preeclampsia can develop into eclampsia, which includes seizures and possibly coma and blindness. Both conditions are dangerous, possibly even fatal to the mother and baby, and need to be treated urgently. Treatment generally involves delivery of the baby in addition to treating the mother with medications to bring the blood pressure down.

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Other Warning Signs

Other headache red flags include a thunderclap headache, which causes severe pain that comes on suddenly. Many people describe this as the worst headache of their life.

Additional symptoms of a thunderclap headache include:

• Numbness
• Difficulty seeing, speaking, or walking
• Nausea, vomiting
• A high fever
• High blood pressure

Contact your healthcare provider immediately, because thunderclap headaches and high blood pressure during late pregnancy can be signs of eclampsia, stroke, or a condition called pituitary apoplexy, or bleeding in the pituitary gland, which controls hormones important for growth, milk production, and other important bodily functions.

Treatment

The good news is that most headaches during pregnancy can be easily relieved with simple remedies like rest, relaxation, a cold compress, and eating and sleeping at regularly scheduled times.

Managing your anxiety and stress is an important part of keeping you and your baby safe. Schedule time to do things for yourself, like going for walks or going out with friends. Maybe try biofeedback, or listen to music or a book on tape.

Healthcare providers generally have considered acetaminophen safe for occasional use during pregnancy. However, in recent years, studies have raised the possibility of an association between prenatal use of acetaminophen and asthma, lower IQ, and other conditions among children.

Another study suggested a possible link between using acetaminophen during pregnancy and behavioral and hyperactivity problems in children by age 7. Due to data limitations and the designs of the studies, researchers couldn't be sure whether it was the drug that caused these problems in children.

Health officials have also warned that using two other kinds of painkillers during pregnancy—non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and opioids such as codeine—may increase the risk of birth defects.

So it's best to always check with your healthcare provider before taking any medication or herbal supplement to make sure it's safe for you and your baby.

Summary

Headaches during pregnancy are common. While they hurt, most aren't anything to worry about. However, changes in hormones, blood volume, and weight that occur naturally during pregnancy can make women more susceptible to headaches that are warning signs of serious medical complications like preeclampsia.

It's important to call your healthcare provider if you suddenly start getting headaches, especially after your 20th week of pregnancy, or if the headaches you normally get change in location, severity, or duration.

It's essential to seek care immediately if you have a headache and other symptoms of preeclampsia such as abdominal pain, swelling in the feet or legs, or problems seeing, walking, or talking.