Evaluation of Headache During Pregnancy

Examples of Benign and Serious Pregnancy Headaches

Some Headaches are Linked to Your Pregnancy
Some Headaches are Linked to Your Pregnancy. Riccardo Botta/EyeEm

While there are many new symptoms that occur during pregnancy, like weight gain, acid reflux, and back pain, there can also be worsening or improvement of existing medical conditions.

For instance, migraines tend to improve during pregnancy, especially in the second and third trimesters. Other conditions, like headache disorders unique to pregnancy, may also arise.

Headache Evaluation During Pregnancy

When evaluating your headache, your doctor will perform a detailed history.

She may ask you questions pertaining to any medical conditions you have, like high blood pressure or depression, or whether you are taking any medications or over-the-counter supplements, like vitamins, caffeine, or laxatives.

Your doctor will also inquire as to the characteristics of your headache such as how intense it is, how long it has lasted, or whether there are associated symptoms like nausea or vomiting. This is done in order to make an accurate diagnosis, as well as to assess headache warning signs and rule out medical emergencies.

Some specific headache warning signs (which may signal dangerous headaches in pregnancy) that warrant immediate medical attention include:

  • "Worst headache of my life"
  • Blurry vision
  • Neurological symptoms like weakness or numbness
  • Headache with fever and/or stiff neck
  • Headache with high blood pressure and/or swelling of the legs and feet
  • Headache related to exertion, sex, or Valsalva maneuver
  • New-onset migraine-like headache
  • Change in headache pain, pattern, or severity

Primary Headaches During Pregnancy

The three most common primary headache disorders are migraines, tension-type headaches, and cluster headaches. While women can develop a new headache disorder during pregnancy, typically these disorders have already existed.

Aside from migraines, tension-type headaches and cluster headaches tend to remain stable during pregnancy.

Migraines are the most common headache in pregnancy but are generally less severe and occur less often than those outside of pregnancy. That said, migraines may be worsened initially during the first trimester, especially with the change in hormone levels in the body and the added stress occurring.

There is some scientific evidence that women with migraines may be at a higher risk of developing preeclampsia and/or preterm birth, although more research needs to be done to tease apart this relationship

Headaches From Preeclampsia/Eclampsia

Preeclampsia and eclampsia are serious medical conditions that can occur after 20 weeks gestation and/or during the postpartum period. Preeclampsia causes high blood pressure and protein in the urine.

In addition to a very high blood pressure, severe preeclampsia may lead to the following symptoms:

Eclampsia is a potentially fatal condition and occurs when a woman has seizures, blindness, and/or coma in the face of severe preeclampsia.

In both preeclampsia and eclampsia, headache is a common symptom and can resemble that of a migraine, characterized often by a throbbing sensation and accompanied by nausea and photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound).

Unlike migraines though, a preeclampsia-related headache may be associated with other worrisome features like blurry or double vision and abdominal pain. Moreover, while migraines tend to occur on one side of the head, a headache from pre-eclampsia is located all over.

 According to an article in Headache, women with a history of migraines are nearly four times more likely to develop preeclampsia than those without a history of migraines.

Treatment of preeclampsia and eclampsia generally involves delivery of the baby, in addition to magnesium sulfate, calcium channel blockers, and possibly anti-seizure medications.

Idiopathic Intracranial Hypertension

Idiopathic Intracranial Hypertension (IIH) is a serious medical disorder that is commonly seen in obese women of child-bearing years. It may occur during any trimester of pregnancy.

IIH causes a headache along with vision changes and pulsatile tinnitus (when people hear a rhythmic sound that matches their heartbeat). People with IIH will have normal brain imaging but will have elevated cerebrospinal fluid pressures when a lumbar puncture is performed.

In addition, women with IIH have papilledema, which a condition characterized by swelling behind the eye due to the increased fluid pressure in the brain. Overall, treatment of IIH is geared towards weight loss or weight management and reduction of the elevated intracranial pressure.

Sometimes intracranial hypertension is caused by another medical condition—this is called secondary intracranial hypertension. The most common cause of secondary intracranial hypertension is cerebral venous thrombosis, which can occur at any stage of pregnancy, but is most common during the postpartum period.

Reversible Cerebral Vascular Syndrome

Reversible cerebral vascular syndrome, also known as Call-Fleming syndrome, is another headache syndrome that can be triggered by pregnancy and may also occur in the postpartum period. People with this headache syndrome usually describe a thunderclap headache, which is a severe, sudden, and explosive onset of head pain.

The cause of this syndrome is unknown, but the origin of the pain is believed to be related to spasm of the arteries in the brain. Treatment is with calcium channel blockers, which is a blood pressure medication that helps to dilate or open the brain arteries.

Keep in mind that if a woman goes to the emergency room with a thunderclap headache, an exhaustive approach to rule out a subarachnoid hemorrhage is imperative before assuming the woman to have a reversible cerebral vascular syndrome.

Other Causes

In addition to the headache disorders mentioned above, there are other potential causes of dangerous headaches, like stroke, meningitis, carotid or vertebral artery dissection, and pituitary apoplexy. There are also potential benign causes like sinusitis, post-lumbar puncture headache, or medication withdrawal headache.

A Word From Verywell

In the end, most headaches in pregnancy are not dangerous. Still, if you experience a headache during pregnancy that is not eased with simple remedies like a cold compresses, sleep, caffeine (if you suspect a caffeine withdrawal headache,) relaxation, and/or food, or if your headache follows a different pattern or shows headache warning signs, be sure to contact your doctor right away.


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Moustafa RR, Allen CM, Baron JC. Call-Fleming syndrome associated with subarachnoid hemorrhage: three new cases. J. Neurol. Neurosurg. Psychiatr. May 2008;79(5): 602–5.

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