Headache in Pregnancy

Headache is one the most common problems that comes for evaluation in a clinical practice. 

Even though most of the headaches are benign and do not need much evaluation but frequent/ episodic headache may cause quite a disability in day to day life and differentiating benign and malignant headaches is important to reduce the anxiety that is so frequently associated with frequent and persistent headaches. 

Headaches may occur frequently during pregnancy, especially first and third trimester.

Sudden hormonal shifts and increase in circulating blood volume may contribute to increase in headache frequency.

In the second trimester, pregnancy-related headaches may disappear as your body becomes used to the hormonal changes.

 Common causes of headache in pregnancy may be as follows:

1. Tension-type headaches (TTH): These are characterized by band like sensation around the head. Woman may feel varied sensation like heaviness, stretching sensation extending from scalp to the neck and shoulders. Following factors may contribute to the development of TTH:

Stress

Fatigue

Lack of sleep

Low blood sugar or hypo-glycaemia

Dehydration

2. Migraines


Episodic headache that is severe, throbbing and affecting both the sides of the head and associated with nausea or vomiting are usually migraine. Even though migraine improves during pregnancy in > 50% of cases, some women may have migraine headaches for the first time in early pregnancy.

3. High Blood Pressure / Pre-eclampsia may present as a sudden, severe unrelenting headache in a pregnant woman.  It may be accompanied by blurry vision, spots in front of your eyes, sudden weight gain, pain in the upper right abdomen, and swelling in the hands or feets and nausea and vomiting.

It requires immediate medical attention, as uncontrolled high BP is associated with complications like placental insufficiency, separation of placenta from the uterus (abruption), decreased platelet count leading to bleeding disorder, cardiovascular insufficiency.

4. Cerebral venous thrombosis - a blood clot in the sinuses of the brain . It may not be a common cause of headache but it is important to recognize this complication as venous sinuses thrombosis occurs more frequently in pregnant and post partum period as compared to general populations and it could be potentially life threatening and could lead to permanent neurological disability. So any new onset headache associated with vision loss and vomiting need neurological evaluation to rule out CVT.

5. Idiopathic intracranial hypertension (IIH). Rarely headache in pregnancy might be due to pressure build-up in the skull, known as IIH. It is more likely to occur in obese women of childbearing age especially if there is an ongoing thyroid problem. It may present as unexplained headache and decreased vision during the pregnancy

HOW DO I MANAGE THESE HEADACHES DURING PREGNANCY

Before taking any painkillers, you must always talk to doctor to check the safety of that drug during pregnancy.  Acetaaminophen (commonly known as Paracetamol) is the safest pain killer during pregnancy, if no medical help is around in a case of acute headache. The following tips may safely help relieve or prevent headaches during pregnancy:

Use warm or cold compresses.

         To soothe a headache in the sinus area, apply warm compresses to the front and sides of your face and around your nose, eyes and temples.

         To relieve a tension headache, apply a cold compress to the back of your neck

Reduce stress.

         Avoid stressful situations.

         Relaxation exercises may help. For instance, try deep breathing or simply closing your eyes and imagining a peaceful scene.

Rest and exercise.

         Resting in a dark, quiet room can soothe headaches.

         Getting good sleep and exercise may help.

Eat well-balanced meals.

         Eat smaller, more frequent meals throughout the day.

         This can help keep your blood sugar from getting too low.

Take care of your body.

         Maintain good posture, especially during the third trimester.

         Get a massage. Massaging your temples, shoulders and neck can help reduce the pain of headaches.

Avoid headache triggers.

         Different kinds of food or stresses can trigger headaches. For instance, triggers of migraine headaches include chocolate, aged cheese, peanuts and preserved meats.

         Keep a diary, and review the kinds of foods and activities that tend to trigger tension or migraine headaches

Medication 

Most of the medicines to treat headache are contraindicated during pregnancy. Even Over the counter drugs should not beg taken without consulting your doctor. Please always ask for pregnancy category of drugs ( according to their potential to cause foetal defects, drugs have assigned pregnancy category and only Pregnancy category A or B should be taken).

Call your doctor for help, if your headache:

         Is sudden and explosive or includes a violent pain that awakens you from sleep

         If headache is associated with decreased vision, seizure, vomiting or any neurological complaint like a limb weakness

         Is accompanied by fever and stiff neck

         Becomes increasingly worse, and you have vision changes, slurred speech, drowsiness, numbness or a change in sensation or alertness

         Occurs after falling or hitting your head

         Is accompanied by nasal congestion, pain and pressure underneath your eyes, or dental pain (these may be signs of sinus infection)

Contributed by:

Dr Sweta Singla

Consultant Neurology and Sleep Disorders

Kalpavriksh Superspeciality Clinic

www.kvsc.in