Headaches in Pregnancy

This article was adapted from an article that Dr Sheikh contributed to in Neurology Advisor.

Approach to headaches in pregnancy-

In general, headaches during pregnancy will be due to a primary reason like migraine or tension type headaches. Thankfully, most headaches during pregnancy will improve. Up to 90% of women note that their migraines improved, esp during the second and third trimester. They can unfortunately worsen again during post-partum. However, if someone has new onset of headaches or other red flags during pregnancy, it is important to do a work up for secondary causes. Given that pregnancy is a time of hypercoagulability, women can be at risk of stroke and venous thrombosis during this time, which can present with headaches as a possible symptom. In women with a previous history of primary headaches, any change in their headache pattern or character also warrants a work up.

Treating headahces in pregnancy-

For women with headaches, pregnancy can present a challenge since many medications are not thought to be safe during this time. Many medications are contraindicated or have not been tested in pregnant women. Therefore, there is overall little evidence of the effects of these medications on the growing fetus. For this reason, there is are few treatments that have a Level A rating for women who are pregnant or breastfeeding. 

One of the first things to try for women with headachces in preganncy, is to avoid possible triggers. Many times, this can be enough to provide some relief, esp focusing on trying to get better sleep and stress reduction.

-Other helpful complementary methods, include  stretching exercises and mild yoga (specific for pregnant women) can be helpful in preventing migraine attacks. 

-Other treatment like a warm compress or resting, esp sleeping can be helpful and a way to avoid taking medications.

-Complementary methods like relaxing breathing exercises or mindfulness can also provide great relief, and are more likely to be effective if they are used as a daily practice or as a preventive.

Generally, most medications should try to be avoided.  However, if needed, triptans which are used to treat migraines, now has a large registry that shows that it is safe in women who are pregnant, although it is still important to check with your physician first to

consider other alternatives and if they are a safe medication in each

situation.

- Most headaches during pregnancy will be primary headaches but still can be disabling.  It is important to discuss the possible worsening of headaches prior to getting pregnant to set up strategies prior to help alleviate possible anxieties.  It is important to work on healthy

lifestyle techniques that are very effective at preventing headaches.