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Prevention and Treatment of Headache in Pregnancy
by Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.
Headaches can be miserable and debilitating, especially during pregnancy, but in most cases they're not dangerous. Warning signs that a headache needs urgent evaluation by a physician include:
- if it is severe and different than any headache you have had before;
- if it occurs immediately upon wakening in the morning or wakes you from sleep;
- if you are already being monitored for high blood pressure and the pain doesn't respond to acetaminophen;
- if it is associated with neurological symptoms, such as vision problems or numbness or weakness, that you have not previously experienced.
Since most headaches do not fit into the above categories, many women are able to manage their pain just fine without a physician's help. Here are steps you can take to manage headaches when you're pregnant, as well as information regarding when you should see your physician.
Headache prevention
When it comes to headaches--especially migraines--prevention is key. If you know what triggers your headaches, the first step, when possible, should be lifestyle change. For example, foods such as cured meats and strong cheeses (which contain the amino acid tyramine), as well as red wine and monosodium glutamate (the food additive MSG) can spawn migraines in some people.
Similarly, a lack of sleep, low blood sugar (which may affect pregnant women who eat irregularly), and alcohol use also can trigger migraine attacks. Migraines are also more common in smokers--yet one more reason to quit.
Tension headaches, too, can occur under avoidable circumstances. Loud noises (like those at rock concerts), sleep deprivation, dehydration, and allergies can all produce headaches.
Pain management
- Nonmedical treatment for pain--Applying a cool compress to your forehead, resting in a cool dark room, taking a nap, gently massaging your temples, or getting a massage all may make you feel better without the use of medications. You also can try using meditation, relaxation techniques, soothing music, or an ice pack for your head or face in concert with pain medications, should you decide to take them.
- Non-narcotic pain medications--Acetaminophen (Tylenol) is the usual first-line treatment for pain in pregnancy. Before third trimester, nonsteroidals like ibuprofen (Motrin, Advil) are generally considered safe. After 32 weeks, potential fetal effects on circulation and kidney function limit the safe use of this class of drugs. One cup of coffee or a caffeinated soda is usually considered safe at any stage of pregnancy and may resolve the headache.
- If the first-line pain therapies don't work--Sometimes narcotic pain medications like codeine, oxycodone (Percodan), and meperidine (Demerol) are prescribed for severe headache in pregnancy. While this type of medication is addictive if used for long stretches of time (weeks or more), short-term use poses surprisingly little risk to mother or fetus, as long as the mother doesn't drive or operate heavy machinery. These are prescription medications that, of course, are taken only in consultation with your OB practitioner. When pain is severe, intravenous or injectable pain medications may be necessary for the mother's well-being. Nausea medication like prochlorperazine (Compazine) may also help.
Medications specifically for migraines
These drugs are recommended as a last resort mostly because healthcare professionals don't have the long-term experience using them during pregnancy that we have with the other therapies. So we can't be sure yet that they're completely safe for pregnant women to take.
- Sumatriptan (Imitrex), a serotonin receptor agonist that comes as a pill, nasal spray, or injection, is very successful in treating migraines. Unfortunately, there is not enough research yet to prove that sumatriptan is safe in pregnancy, and the animal studies that have been done show conflicting results.
Even less data can be found on naratriptan (Amerge), zolmitriptan (Zomig), and rizatriptan (Maxalt), the second generation of drugs in this group. Currently, sumatriptan should only be used if your physician feels that the potential benefit clearly outweighs the potential risk.
- Ergot derivatives like ergotamine (in Cafergot) and dihydroergotamine (Migranal) cause constriction of blood vessels and can trigger uterine contractions. Previous reports have suggested they may cause birth defects. These drugs are category X: not safe for use in pregnancy.
Women who get frequent, debilitating migraines may benefit from daily preventive medications. Talk to your physician if you needed these sorts of drugs before or are having severe problems in pregnancy.
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Created June 16, 2001
Reviewed August 21, 2004
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