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Your Pregnancy Matters

Headache and migraine remedies that are safe during pregnancy

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Occasional, mild headaches during pregnancy usually are nothing to worry about.

Most women deal with headaches at some point in their lives. Data from the Centers for Disease Control and Prevention suggest that one in five women had a severe acute headache or migraine in the previous three months. Additionally, migraines are more common in women than men – approximately 18 percent of women have them compared to 6.5 percent of men.

Because headaches and migraines are so common, it’s probably no surprise that many women deal with them during pregnancy. For the majority of pregnant women, occasional headaches or migraines are no cause for alarm, and most standard treatments are safe. However, suffering a severe headache at key times during or after pregnancy can indicate a serious medical emergency.

Common types of headaches and treatment options

Primary headaches

Primary or acute headaches arise once in a while and typically pass after a few hours. Tension headaches are the most common type and are characterized by muscle tightness and localized pain in the head and neck.

Primary headaches in pregnant women usually can be treated at home. Rest, a neck or scalp massage, hot or cold packs, and over-the-counter anti-inflammatory drugs such as Tylenol, aspirin, or ibuprofen can reduce the pain. However, if you start to have frequent or severe headaches, talk to your doctor to determine the cause.

Migraines

Migraines tend to be episodic (frequent and long-lasting) and typically cause additional neurological symptoms, such as:

● Blurred or tunnel vision

● Hallucinations

● Light sensitivity

● Nausea and vomiting

Studies have shown that migraines can be triggered by hormonal changes, including right before your period or as a result of taking oral contraceptives. Interestingly, some women who have migraines find that the frequency or intensity of their symptoms decreases during pregnancy. Research does not suggest, however, that pregnancy triggers the onset of migraines – if you have your first migraine during pregnancy, it’s likely coincidental.

Treatment during pregnancy is fairly similar to standard treatment. Anti-inflammatory drugs are generally safe and effective during pregnancy when used in a limited manner. Midrin is a commonly prescribed headache medication that contains acetaminophen along with a mild sedative. Midrin also has vasoconstrictive properties, which means it narrows the blood vessels, thereby reducing blood flow and pain. 

Sumatriptan, commonly known as Imitrex, is another medication that reduces blood flow to the brain. It works best to stop a migraine if it’s taken as soon as symptoms present. Most nausea medications prescribed to women with migraines are safe to use during pregnancy, but I suggest reviewing the medications you take for migraine relief with your obstetrician at your first prenatal visit, just to be safe. 

Certain drugs called ergotamines have a stronger vasoconstrictive effect and can adversely affect fetal growth. They also can stimulate uterine activity. Because of this, they absolutely should not be used during pregnancy. 

Severe migraines might require hospitalization so you can receive fluids, pain medication, or anti-nausea medication through an IV if you are unable to keep medications down. 

"Most women don’t require special care for headaches and migraines during pregnancy, and most standard remedies are safe. However, certain types of headaches require immediate medical attention to avoid potentially harmful health issues."

– Robyn Horsager-Boehrer, M.D.

When headaches are secondary to other problems

Headaches can result from other conditions, some of which are life-threatening:

● Stroke: Sudden and severe headaches might be a sign of a stroke. Women who have strokes during pregnancy or after delivery typically describe the pain as the worst headache of their lives. They also might report other symptoms, such as speech problems, vision issues, or functional problems on one side of the face or body. At the emergency room, the doctor will evaluate you for stroke symptoms, such as visual changes, facial drooping, and arm or leg weakness. If you are having or had a stroke, we will get you emergency treatment at our Advanced Comprehensive Stroke Center.

● Preeclampsia: A headache with preeclampsia (a pregnancy complication characterized by high blood pressure) can indicate a dangerous spike in blood pressure. The doctor will assess you and might admit you to the hospital for management of blood pressure and treatment to prevent seizures.

● Spinal fluid leak: A headache after an epidural or spinal block can indicate a spinal fluid leak, especially if it worsens when you sit or stand up. The most effective treatment is an epidural blood patch, in which the doctor injects a sample of your blood into the leaking area, essentially plugging the hole. This therapy provides dramatic relief right away.

Occasional mild headaches are common in women. The vast majority are no cause for alarm and can be treated at home, with guidance from your doctor. However, if your symptoms are severe or something just doesn’t seem right, it’s much better to seek care and be safe rather than sorry.

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