Headaches During Pregnancy

When to Call Your Healthcare Provider

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Headaches during pregnancy can be due to stress, dehydration, or other common causes. They are often easy to remedy with cold compresses, a nap, or even Tylenol (acetaminophen), considered a safer choice during pregnancy while avoiding nonsteroidal anti-inflammatory drugs (NSAIDs).

Yet headaches during pregnancy may be a sign of preeclampsia, which can lead to a potentially fatal condition with high blood pressure and other complications. Or a sudden, severe thunderclap headache can be a symptom of the stroke-like reversible cerebral vascular syndrome.

This article explains what you need to know about the different types of headaches during pregnancy, how to recognize them, and what to do if you think your headache may be a sign of a dangerous complication.

pregnancy and dangerous headache warning signs

Verywell / Laura Porter

Types of Headaches

Headaches are classified by what causes them and fall into two categories:

  • Primary headaches, where the pain itself is the only problem
  • Secondary headaches, where the pain is caused by another medical condition

About 40% of pregnant women report having headaches during pregnancy or postpartum (in the weeks after giving birth). Most are primary headaches and are less worrisome.

However, research suggests that secondary causes of headaches may be more common among pregnant people than previously thought. One study found that between 25% and 42% of pregnant women seeking treatment had a secondary headache.

During the first trimester, headaches can follow nausea, vomiting, and dehydration due to morning sickness. Other causes of headaches during pregnancy include stress, hormonal shifts, caffeine withdrawal, sleep disruptions, and changes in diet and exercise.

Common types of headaches during pregnancy include:

  • Tension headaches: Pain that feels like a tight band around your head, or pain in the neck and shoulders. It's common in pregnancy, accounting for 26% of headaches.
  • Migraines: Pain lasting hours, sometimes days, and may include blurred vision, light flashes, light sensitivity, nausea, and vomiting. It can be a warning sign of complications.
  • Sinus headaches: Pain or pressure around the forehead, cheeks and eyes, along with stuffy nose and congestion
  • Cluster headaches: Pain usually around one eye or side of the head, wakes you up at night, and occurs in patterns. They're relatively rare in pregnant people.
  • Thunderclap headaches: Sudden, severe pain that peaks within a minute, lasts for at least five minutes, and can cause numbness and difficulty seeing, speaking, and walking

It's important to tell your healthcare provider about any headaches you experience during pregnancy.

Headache as a Preeclampsia Symptom

When a headache during pregnancy is accompanied by dizziness, blurred vision, or blind spots, it's time to call your obstetrician or healthcare provider. These could be symptoms of preeclampsia, a condition that usually occurs after the 20th week of pregnancy.

Preeclampsia can damage organs like the liver or kidneys. It can lead to a low number of platelets, which are cells in the blood that are important in the clotting process. One study found that pregnant women with high blood pressure and a headache were 17 times more likely to suffer severe complications, like preeclampsia.

Besides high blood pressure (hypertension), other signs and symptoms of preeclampsia include:

You also may experience abdominal pain, nausea and vomiting, and sudden weight gain.

Pregnant people with type 1 or type 2 diabetes have a two- to four-fold risk of preeclampsia.

Some people with preeclampsia develop a headache that resembles a migraine—a throbbing headache with nausea and/or a sensitivity to light or sound. This is another cue to contact your healthcare provider, especially if you don't normally get migraines or the headache is different.

Managing Preeclampsia

If preeclampsia is suspected, you will likely be sent to the hospital for further evaluation and treatment.

Left untreated, preeclampsia can develop into eclampsia, which includes seizures and possibly coma and blindness. Both conditions are dangerous and possibly even fatal to both the pregnant person and the developing fetus. They need to be treated urgently, generally with delivery of the baby and medication for the parent's high blood pressure.

Can You Prevent Preeclampsia?

If you are determined to be at risk for preeclampsia early in your prenatal care, your healthcare provider may recommend that you take low-dose aspirin to help prevent preeclampsia and its related complications. This is usually started between 12 and 28 weeks, but ideally before 16 weeks.

Headaches Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Other Conditions

Headaches during pregnancy also may result from other conditions, some of which can be serious. They include idiopathic intracranial hypertension (IIH) and reversible cerebral vascular syndrome (RCVS).

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) occurs more often in overweight people and in the first half of pregnancy, usually prior to 20 weeks. It occurs due to increased spinal fluid pressure around the brain, with symptoms of headache.

Other symptoms include:

Cerebral Venous Thrombosis

Cerebral venous thrombosis is a rare type of stroke, accounting for less than 1% of all strokes but about 2% of strokes in pregnant people. You are most at risk during the last trimester of pregnancy and immediately postpartum.

Symptoms are much like IIH, but it's not uncommon for the associated headache to be the thunderclap type. Seizures also may occur.

Reversible Cerebral Vasoconstriction Syndrome

Reversible cerebral vasoconstriction syndrome (RCVS) is more common in the postpartum period, with thunderclap headache as a symptom. Stroke symptoms may occur but can be reversed, although some RCVS cases can lead to permanent damage or death.

Headache After Epidural

Some people may experience a headache after an epidural, the lumbar spine puncture used to deliver anesthesia during labor and delivery. Called a postdural puncture headache, it will usually occur within the first five days after delivery.

The condition often gets worse if you sit up or stand quickly. Most cases will resolve on their own, but you also may experience nausea, dizziness, ringing in the ears, and neck stiffness with this type of headache.

Thunderclap Headache and Warning Signs

Thunderclap headaches can be a sign of eclampsia, IIH, RCVS, pituitary apoplexy, and other conditions. Associated symptoms include numbness, trouble seeing or speaking, and difficulty walking. Contact your healthcare provider immediately for a diagnosis.

Treatment

Headaches during pregnancy usually can be relieved with simple remedies like rest, relaxation, a cold compress, and eating and sleeping at regularly scheduled times. Managing your anxiety and stress is an important part of a healthy pregnancy. You can try:

Healthcare providers generally have considered acetaminophen safe for occasional use during pregnancy. However, in recent years, studies have raised the possibility of an association between prenatal use of acetaminophen and asthma, lower IQ, and other conditions among children.

Health officials have also warned that using two other kinds of painkillers during pregnancy—non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and opioids such as codeine—may increase the risk of birth defects.

Always check with your healthcare provider before taking any medication or herbal supplement to make sure it's safe for you and the developing fetus.

If you never get headaches and you get one during pregnancy, or the pain you're experiencing is different, more severe, or longer-lasting than your usual headaches, call your healthcare provider, as this can be a warning sign.

Summary

Headaches during pregnancy are common. While they hurt, most aren't anything to worry about. However, changes in hormones, blood volume, and weight that occur naturally during pregnancy can make you more susceptible to headaches that may be warning signs of serious medical complication, like preeclampsia.

It's important to call your healthcare provider if you suddenly start getting headaches, especially after your 20th week of pregnancy, or if the headaches you normally get change in location, severity, or duration.

Seek care immediately if you have a headache and other symptoms of preeclampsia such as abdominal pain, swelling in the feet or legs, or problems seeing, walking, or talking.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Mark Foley, DO
Mark Foley, DO, is a family physician practicing osteopathic manipulative medicine, herbal remedies, and acupuncture.