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| |    Headaches in Pregnancy by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Painful headaches, like many ailments, can occur in pregnancy just as they do at other times of life. However, there are a few causes of headache that are related to pregnancy, some of which may signal a pregnancy complication. And, as you might expect, treating headache in pregnancy has to take into account any risk to the fetus posed by medications as well as the comfort of the mother-to-be. An important general rule is, a severe headache that is unlike any prior headaches you've experienced always deserves evaluation by a physician whether you are pregnant or not. Tension headache Tension headaches are common in pregnancy and will usually respond to over-the-counter pain medications. Most people who have had tension headaches will recognize the classic symptoms of bandlike pain across the forehead or at the back of the head and not feel alarmed. In most instances, headaches that respond to acetaminophen (Tylenol)--which is safe for pregnant women to take--are unlikely to be signs of a serious problem. Migraine Migraine headaches usually occur on one side of the head and often trigger nausea, vomiting, and/or light and sound sensitivity. Some people notice neurological symptoms, such as seeing wavy lines or spots or experiencing numbness on one side of the body, before the migraine starts. Migraine headaches are extremely common in women of childbearing age; around 15 percent of all women get them. Although the symptoms of migraine can be awful, the condition itself does not put women who are expecting at any increased risk of pregnancy complications. Some women may note an increase in frequency of their migraine headaches in the first trimester of pregnancy and postpartum, but the good news is that more than 60 percent of migraine sufferers find relief from their headaches as they make their way through pregnancy. Women who used to get migraines around the time of their menstrual period are particularly likely to improve while pregnant. New onset of migraine in pregnancy is fairly uncommon and warrants evaluation by a physician. Sinus headache Pregnancy often leads to increased nasal congestion, so sinus infection is not uncommon. The usual symptoms of a sinus infection are a stuffy head and yellow or green drainage, sometimes accompanied by fever. Decongestants, pain medications, and, of course, treating the infection usually resolve the headache. Caffeine-withdrawal headache Ideally, women who suspect they are prone to caffeine-withdrawal symptoms should consider cutting down or quitting caffeine before becoming pregnant. In general, however, that's not the case. Many women end up giving up caffeine cold turkey when they find out they are pregnant and then experience a headache for several days as their bodies adjust to their new caffeine-free state. Ask your practitioner if she would rather that you slowly cut down over a few weeks or take pain medications to get through the rough days. Sometimes just realizing that the headache is caused by caffeine withdrawal is reassuring, knowing that it's not something more serious and that you'll only have to withstand a few days of misery. Headache and high blood pressure Headache associated with pregnancy-induced hypertension or pre-eclampsia can indicate a worsening of the condition. Persistent headache that does not respond to acetaminophen should be reported to your practitioner, especially if you are being monitored for high blood pressure. Headache after epidural or spinal anesthesia A small percentage of women who undergo a spinal or an epidural during labor and delivery will get a so-called spinal headache within a few hours to a few days afterward. This kind of headache, caused by leaking out of spinal fluid, can be felt in the forehead, the back of the head, or all over. The pain may be severe, dull, or throbbing. It usually feels much worse when you are standing or sitting and better when lying down. If you have been upright for a while, though (for several hours or more), it may take a while to feel better after lying back down. If the headache doesn't respond to pain medication and caffeine, you or your OB practitioner may need to contact your anesthesiologist for further treatment. Sometimes a blood patch, where a bit of your own blood is injected into the spinal canal, can plug the leak and improve your symptoms more quickly.
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