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Headache in Pregnancy

November 24, 2020

Sorry to hear that your head hurts.

This health decision guide is designed for pregnant women who experience a headache that is either new or different from prior headaches. However, a pregnant woman with persistent headaches may also find some helpful information in the guide.

There are many possible reasons why you have a headache. By answering this series of questions, you will learn about the cause or causes likely to be most relevant to you.

This guide is a learning tool and not a substitute for consultation with your own doctor.

Let's get started.

Click here to begin.

Most headaches, even very severe ones, are not associated with a serious medical problem; however, it is important to first identify a headache that needs immediate medical attention.

Sudden onset severe pain that is different from any type of headache that you have ever experienced before always requires medical evaluation.

Is this the worst headache of your life?

Yes, this is the worst headache ever.

No, this is not the worst one.

Is the headache getting progressively worse?

Yes, it is.

No, the headache is about the same.

There are still many possible reasons for your headache. With a new headache during pregnancy, preeclampsia needs to be considered.

Do any of the following apply to you?

- A prior history of toxemia or preeclampsia

- Mention of your blood pressure being high, even a little high

- Swelling of your feet or ankles

- Marked weight gain recently

- Discomfort in the belly, especially on the right side

Yes, one or more of these applies to me.

No, none of these applies to me.

Now, a few more questions that apply to everyone with a new or different headache.

Did your headache begin following a head injury?

Yes, it started after a head injury.

No, my headache did not occur after a blow to the head.

Another question to help determine if you need immediate medical attention.

Are you experiencing any of the following symptoms?

- Unexplained fever (for example, no flu or cold symptoms)

- Marked increased pain when you bend your head forward

- Stiff neck

- Blurred or double vision

- Confusion

Yes, I am experiencing one or more of those symptoms.

No, I am not experiencing any of those symptoms.

It's quite predictable to have a headache following any blow to the head. But certain symptoms raise concern that brain injury may have occurred.

Are you experiencing any of the following symptoms?

- Nausea and vomiting

- Memory problems

- Difficulty communicating

- Blurred vision

Yes, I have one or more of these symptoms.

No, I don't have any of those symptoms.

Your headache is most likely related to the blow to your head. Your symptoms should improve over the next 24 - 48 hours.

If you are not improving, contact your doctor. Call sooner if the headache is getting worse or if you develop new symptoms in addition to the headache.

It's possible that your headache is due to something else.

Click here to learn about other possible reasons for your headache.

Another question to help determine if you need immediate medical attention.

Are you experiencing any of the following symptoms?

- Fever and severe headache without any symptoms of the flu, a cold, or respiratory infection

- Confusion

- Marked increased pain when you bend your head forward

- Stiff neck

- Uncontrolled vomiting

Yes, I am experiencing one or more of those symptoms.

No, I am not experiencing any of those symptoms.

Great. Let's continue.

One last question to see if you need to call for advice now. A severe headache in the last several months before expected delivery could indicate a rise in blood pressure and preeclampsia. This might be the only initial symptom.

Are you past 6 months of your pregnancy?

Yes, I am more than 6 months pregnant.

No, my pregnancy is not that far along.

Good news so far. Based on your answers, a serious medical problem that needs immediate evaluation is unlikely.

Viral infections such as colds and flu often cause a headache.

Do you have symptoms suggestive of the flu or a cold, such as a sore throat, nasal congestion, cough, muscle aches, and fever?

Yes, I think I have a cold or the flu.

No, I don't have those symptoms.

So far, your answers indicate that you have a new or different headache without any fever, symptoms of infection, or stiff neck. You also indicate that you are thinking clearly without confusion.

Next let's consider whether you rarely get headaches or you do get headaches quite often. People who have migraine or get other types of headaches will almost always experience at least one headache that is more severe or feels a little different than prior headaches.

Do you have a history of migraine or recurrent headaches?

Yes, I have problems with recurrent headaches.

No, I rarely get headaches.

Sinus infections can cause a headache. However, the pain of a sinus infection is usually in the front and tends to be localized to one side of the forehead, around the nose, or behind one or both cheeks. The pain from a sinus infection often gets worse when you bend forward. Also mucus from your nose changes color to yellow, green, or reddish-brown.

Do you have symptoms that suggest a sinus infection?

Yes, this sounds like me.

No, I don't have these symptoms.

You probably can take acetaminophen (Tylenol). But be certain that you don't exceed the doses specified on the bottle. Women with liver disease such as chronic hepatitis should consult with the doctor or midwife prior to using acetaminophen.

Now that you are pregnant, do not take any other medications for headache without calling your doctor or midwife first.

Call your doctor if you cannot get the head pain under control or you start to have nausea and vomiting.

There still could be some other reason for your headache.

Click here to learn about other possibilities.

Sinus infections can cause a headache. However, the pain of a sinus infection is usually in the front and tends to be localized to one side of the forehead, around the nose, or behind one or both cheeks. The pain from a sinus infection often gets worse when you bend forward. Also mucus from your nose changes color to yellow, green, or reddish-brown.

Do you have symptoms that suggest a sinus infection?

Yes, this sounds like me.

No, I don't have these symptoms.

An important but uncommon cause of headaches is carbon monoxide exposure. Clues that carbon monoxide may be the cause include:

- Headaches that occur only in your home

- Cold weather requiring windows to be shut

- A gas smell in your home

- Using a wood-burning or coal stove

- Other family members complaining of headache

Is there any chance that carbon monoxide levels are high in your home?

Yes, this may be true.

No, this does not apply to me.

Next, let's consider the time of day you have a headache. Headaches that occur when you wake up in the morning may indicate a problem with abnormal breathing during sleep. Sleep apnea has become a well-known cause for early morning headaches.

Do you have a headache when you wake up in the morning?

Yes, I have early morning headaches.

No, my headache occurs at different times.

Sleep apnea is less likely but still worth considering if you:

- Snore loudly

- Feel drowsy all day

- Fall asleep during the day while watching TV, reading, or driving the car

Do your symptoms suggest sleep apnea?

Yes, I have these symptoms.

No, I don't have these symptoms.

Now let's explore some other common reasons why people have headaches.

Withdrawal from caffeine can cause headaches.

Have you recently cut back on caffeine-containing products such as coffee, tea, or other caffeinated beverages?

Yes, I have cut back on caffeine.

No, my caffeine consumption has not changed.

Sleep apnea can cause periods of low oxygen levels in your blood and the blood supplying the placenta. Sleep apnea increases the risk of premature delivery and low birth weight of the newborn.

Call your doctor or midwife to discuss the possibility of sleep apnea.

Click here to continue.

You may have sleep apnea. Other symptoms in addition to early morning headaches include:

- Loud snoring

- Feeling drowsy all day

- Falling asleep during the day while watching TV, reading, or driving the car

Sleep apnea can cause periods of low oxygen levels in your blood and the blood supplying the placenta.

Sleep apnea increases the risk of premature delivery and low birth weight of the newborn.

Call your doctor or midwife to discuss the possibility of sleep apnea.

Click here to learn about other common reasons for new or more severe headaches.

Now let's explore some other common reasons why people have headaches.

Many women opt to stop or at least cut way back on coffee and other beverages with caffeine when they become pregnant. Withdrawal from caffeine can cause headaches.

Have you recently cut back on caffeine-containing products such as coffee, tea, or other caffeinated beverages?

Yes, I have cut back on caffeine.

No, my caffeine consumption has not changed.

Experts debate how much caffeine is safe during pregnancy. Most doctors agree that one cup per day is safe. Some studies suggest that three cups or more may increase the risk of miscarriage, especially during the first three months of pregnancy.

Click here to finish.

This is a likely cause of your headaches. Experts debate how much caffeine is safe during pregnancy. Most doctors agree that one cup per day is safe. Some studies suggest that three cups or more may increase the risk of miscarriage, especially during the first three months of pregnancy.

The headache should improve as your body and mind adjust to lower amounts of daily caffeine.

Click here to finish.

You have come to the end of the guide. We have covered the most common reasons for headache during pregnancy.

We hope that this guide has provided some insight into what may be causing your headache.

If your headache persists, contact your doctor or midwife.

Get fresh air immediately and then make sure your family members also get fresh air.

Call immediately for medical advice or go to an emergency department.

Most sinus infections are caused initially by a virus or allergies. Swelling and mucous buildup prevent the sinus from properly draining. Pressure increases inside the sinus, causing pain. You can safely use saline nasal sprays to help clear the mucus from the back of your nose and acetaminophen (Tylenol) to help decrease the pain. But be certain that you don't exceed the doses specified on the bottle. Women with liver disease such as chronic hepatitis should consult with the doctor or midwife prior to using acetaminophen.

Doctors and midwives have different opinions regarding the safety of decongestants, such as pseudoephedrine. Almost all recommend that women who are less than 14 weeks pregnant avoid them.

When the sinus problem is related to allergies, you might be able to take an antihistamine. Ask your doctor or midwife which one they prefer.

If the symptoms are not improving over two to three days, contact your doctor. Call sooner if the pain is getting worse or you develop a fever.

The headache should resolve as your other symptoms improve. Most pregnant women can take over-the-counter acetaminophen (Tylenol); however, be certain that you don't exceed the doses specified on the bottle. Women with liver disease such as chronic hepatitis should consult with the doctor or midwife prior to using acetaminophen.

If the headache gets worse or doesn't resolve over the next several days, contact your doctor for advice.

Call for advice now. Based on your answers so far, the headache is probably not serious. But it is always a good idea to get medical advice when you have a new headache during the last trimester of pregnancy.

You need immediate medical evaluation. The good news is that most headaches, even the very severe ones, are not caused by a serious medical condition. However, you do need to be evaluated because these symptoms sometimes indicate bleeding into the brain, a brain infection, or elevated pressure inside the brain.

Call for medical advice now. The doctor or advice nurse will tell you whether you need an immediate check on your blood pressure and an evaluation for preeclampsia, or if it can wait until the next day or two.

Because your headache is getting worse, you should call for medical advice now. It's unlikely that you have anything serious causing the headache. With your pregnancy, a headache that is not going away might indicate a rising blood pressure and perhaps preeclampsia.

Be sure to tell the doctor or advice nurse about any other symptoms you may be having such as ankle swelling or sudden weight gain.

It's quite predictable to have a headache following any blow to the head. But certain symptoms raise concern that brain injury may have occurred.

Are you experiencing any of the following symptoms?

- Nausea and vomiting

- Memory problems

- Difficulty communicating

- Blurred vision

Yes, I have one or more of these symptoms.

No, I am not experiencing any of those symptoms.

Because your headache is getting worse, you should call for medical advice now. It's unlikely that you have anything serious causing the headache. With your pregnancy, a headache that is not going away might indicate a rising blood pressure and perhaps preeclampsia.

Be sure to tell the doctor or advice nurse about any other symptoms you may be having such as ankle swelling or sudden weight gain.

Contact your doctor now or arrange for immediate evaluation. You may have a concussion or more serious brain injury.

You need immediate medical evaluation. This is always worrisome and scary. The doctors will need to consider the possibility of preeclampsia, bleeding into the brain, or a brain infection. But most of the time, your headache will not be caused by a serious medical condition.

Disclaimer:

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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