Should I Worry About Postpartum Headaches?

Postpartum headaches are common. Causes can include simple things like hormonal changes, medication, and sleep irregularity.

Sometimes, however, a postpartum headache can be a sign of something more serious. People with a headache caused by a condition such as preeclampsia or stroke will typically have other symptoms such as high blood pressure, stiff neck, or seizures.

This article looks at some of the common causes of postpartum headache and how these conditions are usually treated.

What Causes Postpartum Headaches?

Headaches are common in the first weeks after childbirth, occurring in around 1/3 of those who have just given birth. Around 75% of these headaches are not serious and resolve within a few weeks.

Hormonal Changes

A sharp drop in the hormone estrogen after delivery can lead to migraine and tension-type headaches.

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. People who experience postpartum migraines typically have a prior history of migraines, but postpartum can be the first time they present due to the fluctuations in hormones after delivery.

Lifestyle Factors

After childbirth, most people experience significant changes in their eating and sleeping patterns. If you aren't getting enough sleep or are eating poorly, you could experience headaches. Emotional stress can also contribute to postpartum headaches.

Headaches can also be caused by withdrawal from caffeine. If you regularly drank coffee before you gave birth, you may experience headaches during your recovery if you do not resume drinking caffeinated beverages.

If your headache is caused by caffeine withdrawal, you may experience symptoms within the first 24 hours after your last cup of coffee. Your headache may last up to 9 days.

Medications

Many people receive medication during childbirth. If you have pregnancy-related hypertension, for example, you may be given medications such as:

• Procardia (nifedipine)
• Aldomet (methyldopa)

These medications can cause headaches along with other symptoms like dizziness.

If you received Zofran (ondansetron) for nausea, you may also experience headaches.

Lactation Headache

Some people experience headaches during breastfeeding, but the reasons aren't well understood. Some experts believed lactation headaches may be related to fluctuations in hormones, but studies have yet to find a clear link. 

Preeclampsia/Eclampsia

Headaches may be a symptom of preeclampsia or eclampsia. Although these disorders usually present during pregnancy, developing after 20 weeks' gestation, you may not have any symptoms until after delivery.

Gestational Hypertension

Gestational hypertension is a type of high blood pressure that occurs during pregnancy. It develops into preeclampsia in around half of cases. People with this condition may also develop a postpartum headache. 

Stroke

It is possible to have a stroke during the postpartum period, though this is rare. Strokes after childbirth are caused by an increased tendency for the blood to clot. Besides headache, a stroke may cause symptoms such as:

• Seizures
• Muscle weakness

A stroke is an emergency that requires immediate medical care.

Postdural Puncture Headache

If you had an epidural during childbirth, you may experience a condition called a postdural puncture headache (PDPH). This occurs when the epidural needle accidentally punctures the membrane surrounding the spinal cord (called the dura). 

When this happens, cerebrospinal fluid can leak through the puncture, causing headache, stiff neck, and other symptoms. PDPH headaches usually appear within five days of getting an epidural and tend to last around two weeks.

PDPH is associated with a high risk for more than just headaches; it can lead to serious neurological disorders, bacterial meningitis, ongoing low back pain, and postpartum depression. Be sure to speak with your doctor about any persistent headaches so you can be properly diagnosed and treated for this condition.

Rare But Serious Causes

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

• Subarachnoid hemorrhage
• Meningitis
• Pituitary apoplexy
• Arterial dissection
  

How Long Do Postpartum Headaches Last?

Postpartum headaches can last from several hours to several days, depending on the cause. Migraine headaches typically last between four and 72 hours while others may last for longer.

When Should I See a Healthcare Provider?

Red flag warning signs to seek emergency medical care include experiencing pain that is not relieved by typical measures such as fluids, rest, relaxation, or over-the-counter headache medications.

Other headache warning signs include:

• Fever
• Stiff neck
• A thunderclap headache that strikes suddenly with explosive pain
  
• New-onset migraine-like headache
• Loss of movement, which may be related to focal neurological deficits

Headaches Doctor Discussion Guide

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What Can I Do About Postpartum Headaches?

For both migraine or tension-type headache, pain medication, fluids, and sleep will be recommended.

If you are breastfeeding, be sure to talk with your healthcare provider before taking any medications to relieve a headache. Some research suggests, though, that breastfeeding itself may help relieve headache pain.

In addition, try relaxation techniques that work for you such as meditation, light exercise, or breathing exercises.

Medical Treatments

If your headache has a more serious cause, you may need treatment at a hospital or prescription medication. Treatment depends on the cause of the headache.

Stroke requires immediate medical attention. Treatment may include thrombolysis, which is when medication is used to break up a blood clot. Sometimes surgery to remove the blood clot may be necessary.

If you have high blood pressure and protein in your urine, your healthcare provider will likely give you medication to bring your blood pressure down and/or medication (magnesium sulfate) to prevent seizures. If your symptoms don't resolve with the above treatment, brain imaging may be recommended.

If you have a post-lumbar puncture headache, intravenous fluids, caffeine, or even a blood patch can be helpful. A blood patch is when your own blood is injected into the puncture site where your epidural was done. This compresses the hole, preventing any further spinal fluid leak.

Summary

If you experience a postpartum headache, contact your healthcare provider, or page your nurse if you are still in the hospital. There's likely a simple solution, such as sleep, fluids, or pain medication.

Sometimes, postpartum headaches can have more serious causes such as preeclampsia or stroke. If you experience headache along with other symptoms such as fever or stiff neck, seek medical help right away.