Benign and Serious Causes of Headaches After Pregnancy

A thorough evaluation is needed for diagnosis

Mother Holding Newborn
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After the emotional and physical exhaustion of delivering a baby, the last thing you need is a headache. But a headache in the postpartum period is a common complaint. Hormonal changes, dehydration, anesthesia, and sleep irregularity can all contribute to headache after delivery of your precious newborn.

Usually, fluid, rest, relaxation, and an anti-inflammatory medication  (like ibuprofen) alleviates the discomfort. But sometimes headaches in postpartum women last longer than 24 hours, are more severe than usual, and/or are not relieved by typical measures.

When this happens, you should contact your healthcare provider, as this could signal a medical condition specific to the postpartum period (which can rarely be life-threatening).

Causes of Postpartum Headache

In a study in the American Journal of Obstetrics & Gynecology, researchers from the University of Cincinnati College of Medicine reviewed the outcomes of 95 women with postpartum headache. These women had no prior history of seizures or strokes. In the study, the postpartum period was described as occurring 24 hours from the time of delivery to within 42 days after delivery (so a pretty long time out).

The study found that nearly 50 percent of the women's postpartum headaches were either migraines or tension-type headaches. Twenty-four percent were caused by preeclampsia/eclampsia, and 16 percent were spinal headaches. The other 10 percent of the patients had more serious brain abnormalities, including bleeding into the brain and stroke.

Serious Headaches

Examples of rare but dangerous headaches that require immediate medical attention include:

To rule out these potentially life-threatening headache causes, imaging of the brain with a CT scan or MRI is required. A lumbar puncture is also sometimes needed. 

While your doctor may order a brain imaging test to be on the safe side, this is generally reserved for women who have worrisome signs or symptoms along with their headache. For instance, a neurological problem like blurry vision, difficulty walking, weakness, or numbness and tingling is worrisome for a blood clot or bleed in the brain. 

Another headache warning sign is if a woman is having the worst headache of her life or is experiencing a thunderclap headache.

Still, other headache warning signs, include:

  • Headache with fever and/or stiff neck
  • Headache related to exertion, sex, or Valsalva maneuver
  • New-onset migraine-like headache
  • Change in headache pain, pattern, or severity

Preeclampsia/Eclampsia: Another Serious Headache

Another serious headache disorder (that may develop after 20 weeks gestation or during the postpartum period) is preeclampsia/eclampsia, signaled potentially by a headache with high blood pressure and/or swelling of the legs and feet.

To rule out preeclampsia, your doctor will check your blood pressure and perform a urinalysis. If you have high blood pressure and protein in your urine, your doctor will likely give you medication to bring your blood pressure down and/or medication to prevent seizures, called magnesium sulfate. If your symptoms don't resolve with the above treatment, brain imaging may be recommended.

Migraine or Tension-Type Headache

After ruling out potentially life-threatening and serious causes of a postpartum headache, the diagnosis of your headache at this point is probably a migraine or tension-type headache.

A migraine is classically throbbing in nature, one-sided, and associated with nausea and/or vomiting, and a sensitivity to light and sound. The pain of a migraine tends to be much more disabling than the pain of a tension-type headache, which causes a dull tightening or pressure sensation on both sides of the head.

For both of these primary headache disorders, pain medication, fluids, and sleep will be recommended.

Spinal Headache

If you underwent an epidural for anesthesia during delivery, you may be suffering from a post-lumbar puncture headache (spinal headache). In this case, intravenous (through the vein) fluids, caffeine, or even a blood patch can be helpful. A blood patch entails a surgery, in which your own blood is injected into the puncture site where your epidural was done. This compresses the hole, preventing any further spinal fluid leak.

A Word from Verywell

If you experience a postpartum headache, contact your doctor, or page your nurse if you are still in the hospital. There's likely a simple solution, such as sleep, fluids, or a pain medication. However, your doctor will want to make sure there is nothing more serious going on. As a parent, you also want that reassurance so you can obtain appropriate headache relief and get back to enjoying your newborn.

View Article Sources
  • Klein AM, Loder E. Postpartum headache. Int J Obstet Anesth. 2010 Oct;19(4):422-30.
  • Lee M-J, Guinn D, Hickenbottom S. Headache in pregnant and postpartum women. In:UpToDate, Lockwood CJ, Swanson JW (Ed), UpToDate, Waltham, MA 2017.