Your Guide to Treating Headaches During Pregnancy

Pregnancy headaches can have a few different causes, so here are some tips for managing the pain and discomfort.

Pregnant woman holding head
Photo: g-stockstudio/Shutterstock

For some people, the occasional headache might mean popping an over-the-counter pain reliever and continuing on with your busy life. If you're pregnant, though, your medication options might be a little restricted at the moment. That might feel like a cruel irony since some of the common hallmarks of pregnancy—such as fatigue, changes in fluid volume, and hormonal changes—can all also trigger headaches.

Dealing with a headache, along with some of the other discomforts pregnancy can bring, can be a challenge, but there are some strategies that might help ease your pain.

Types of Pregnancy Headaches

In general, most headaches are considered tension headaches, and they're usually described as a tight band of pain around the head and sometimes at the back of the neck. Emotional factors—like stress—often cause them, but there's a wide range of physical causes too. Eyestrain—from poor lighting or sitting too long at a computer—for example, can bring on a headache.

Sinus headaches, where the pain sits behind the forehead, cheeks, or the bridge of your nose, are less common, but they happen if an infection or allergy causes an inflammation that blocks mucus from draining into the nose.

Finally, there are migraine headaches. If you've endured them, you know that the word "headache" doesn't quite describe the debilitating pain, which is often associated with nausea or sensitivity to light or noise. A wide range of things can trigger migraines, including weather changes, menstrual cycles, and certain foods.'

Why Does My Head Hurt?

Some pregnant people often experience tension headaches during the first trimester. "It's most likely because of fluctuations in hormones," says Sheena Aurora, M.D., director of the Swedish Headache Center, in Seattle. "By the second trimester," she says, the pain subsides because "the hormones are steadily high."

Of course, there are many other possible reasons for your throbbing head. ″Ask yourself, 'Are my headaches being stimulated by something in my diet?'″ says Lillian Schapiro, M.D., an OB-GYN in Atlanta. ″'What medications am I taking? What time of day are they happening? Is there anything [I'm doing that] I can change?'″

In the third trimester, when you're carrying the additional weight of your growing baby, consider whether positional changes might be a factor in your headaches. For instance, strain on your neck and shoulders could lead to muscle spasms, which can irritate nerves in the back of your head. Or you might develop muscle tightening and spasms from sleeping with your head in an unnatural position.

Track Your Triggers

If you're suddenly experiencing new headaches during your pregnancy, it might help to do some reflection on if there are any common triggers that lead to them.

For instance, realizing what brought on her headaches made all the difference for Pittsburgh native Margaret Delle. "My midwife suspected that [they] might be caused by dehydration," she says. "She recommended that I guzzle huge amounts of water. It worked wonders!" Other signs of dehydration include dark yellow urine or a woozy feeling. "The uterus is using a lot of blood," Dr. Schapiro explains. And uterine blood flow nourishes your developing baby. "So if you get behind on your fluid intake, there's more strain on other parts of the body." For some people, that can lead to headaches.

Your own headache solution may not be as easy as drinking water; it might be a matter of eating smaller meals more frequently to prevent low blood sugar, squeezing in a daily nap to stave off exhaustion, or practicing good posture to avoid muscle strain. If you're feeling the headachy effects of cutting back on caffeine, the cure might be simply waiting it out for a while. According to Dr. Aurora, "Caffeine withdrawal headaches should last only two or three days."

Some headaches are tougher to elude. If the problem is a sinus infection, hold a warm compress around your eyes and nose for relief. ″You're trying to soften the mucus in there and make it come out,″ says Dr. Schapiro. Call your doctor if pain is accompanied by a fever, since you might need a course of antibiotics. If you want to try a natural method for treating a tension headache, hold a cold compress or ice pack at the base of your neck. ″You're trying to constrict the bulging blood vessels,″ says Dr. Schapiro.

Safe Meds

Fortunately, not all pain relievers are off-limits. That's happy news for Kim Battista, of Bridgeport, Connecticut, who has battled headaches throughout two pregnancies. ″I've had three sinus infections in the last four months,″ she says. ″It hasn't been fun!″ Battista used to treat a headache by popping an Advil and resting for 20 minutes. ″But when you have a 16-month-old at home, there's no resting,″ she says. ″And when you're pregnant, there's no Advil!″

It's true: Doctors advise against pain relievers like ibuprofen (Advil), naproxen (Aleve), and aspirin. They also discourage taking other common headache and migraine medications containing triptans, such as Imitrex, Amerge, and Relpax, due to a lack of data. But most health care providers are comfortable prescribing acetaminophen—aka Tylenol—within dosing guidelines. Dr. Aurora suggests taking no more than two or three 500-milligram tablets a week.

If your doctor determines that you need something stronger, they might also suggest a prescription medication that contains both acetaminophen and a mild narcotic or sedative, like Darvocet or Fioricet, though little is known about the risk to fetuses. "In the beginning, I really tried not to take medicine," says Battista. "But once I gave in and took Fioricet, I realized I was much better off." According to Mayo Clinic, drugs containing butalbital—like Fioricet—may increase the chance of birth defects, so it's best to discuss with your doctor before starting anything.

If you opt for a pill, take it as soon as you feel the pain coming on. Says Dr. Aurora, "Once a headache is prolonged, the nerves [that are causing the pain] become more active." But first check with your doctor, who knows your medical history and what other drugs you may be taking.

If the pain is severe and/or accompanied by nausea or vision loss, your doctor will want to see you immediately. You may have a more serious issue, like preeclampsia, a pregnancy disorder involving high blood pressure. Or, in very rare cases, pregnancy can bring a previously unknown health condition to light. For example, someone with a vascular lesion on the brain might never show symptoms of this condition until they get pregnant—when the increased blood pressure of pregnancy affects their condition. In such an unlikely instance, you would be admitted to the hospital for further monitoring.

What About Migraines?

A migraine is more than just a headache; it's a neurological condition that involves much more severe pain. There are an estimated 37 million migraine sufferers in the U.S., but women experience migraine disorder three times more than men. But there's good news: many migraine sufferers actually find that their migraine symptoms (such as aura) actually get better during pregnancy. For others, they intensify in the first few weeks of pregnancy, then disappear after the first trimester. That's because, for many menstruating individuals, migraines are triggered by hormonal fluctuations around their periods. But once they get pregnant and pass the first trimester, their hormones remain at a steady level.

That's what happened to Brandy Surber, of Stanaford, West Virginia. ″Since becoming pregnant, I've had fewer migraines,″ she says. ″During my first trimester, though, I experienced three or four.″ When she contacted her doctor, she learned that her regular medication was off-limits during pregnancy.

In fact, the most popular migraine painkillers are considered category C, which means we don't know if they're safe or not, says Merle Diamond, M.D., associate director of the Diamond Headache Center in Chicago. She adds, however, that in certain cases, a doctor might determine that an NSAID (non-steroidal anti-inflammatory drug) is in her patient's best interest. Another class of migraine drugs, ergotamine derivatives (like Cafergot), is category X. "Never use them, ever," Dr. Diamond says. This lack of options frustrated Surber, who says that prior to becoming pregnant, "I'd gotten used to treating my migraines instead of riding them out."

The problem is even more difficult for those people—an unlucky minority—whose migraines become more intense and frequent during pregnancy. So what can a migraine sufferer do? "Focus on trying to prevent them," says Dr. Aurora. She suggests non-pharmacological options like biofeedback, physical therapy, massage, or acupuncture. And, obviously, avoid your personal migraine triggers. Gradually, Surber has found natural ways to manage her pain. "It's lessened by elevating my legs, drinking more water, and taking a 30-minute nap," she says. "I'm going to do my best to try to stay medicine-free while breastfeeding!"

If "medicine-free" just isn't for you, ask your doctor for viable drug options. "We use Tylenol with codeine pretty comfortably," says Dr. Diamond. Beta-blockers, which are used to lower blood pressure, can also prevent migraines and are considered relatively safe during pregnancy. If the pain is accompanied by vomiting, your doctor might prescribe an anti-nausea medication like Zofran. Don't just assume that being pregnant means you have to suffer from headaches and migraines—your doctor wants you to find a solution that can ease your discomfort, as that's the healthiest thing for both you and your baby.

They may be painful, but keep in mind that most headaches are harmless. Even migraines haven't been shown to pose a risk to your baby. (Although, of course, if you are having a sudden, new-for-you headache along with any other symptoms, especially vision changes or sudden swelling, be sure to call your doctor right away.) And here's an encouraging reminder: "Once you break a headache," says Dr. Schapiro, "it usually stops [for good]." So you can focus on your other pregnancy complaints. Constipation, anyone? Aching back?

At-a-Glance Treatments

While your best bet is to treat headaches with natural means, sometimes that just doesn't cut it. Before taking any medications—even over-the-counter pain relievers like Tylenol that are typically considered safe—talk to your doctor. Call your doctor if your treatments aren't working, or if your headaches get worse or more persistent. Here's what's safe—and what's not.

  • Safest: Natural methods (such as a massage from your partner, cold or warm compresses, a bath); acetaminophen (Tylenol)
  • Next Steps: Prescription drugs containing both acetaminophen and a mild sedative or narcotic (such as Darvocet or Fioricet)
  • Not Advised: Pain relievers such as ibuprofen (Advil), naproxen (Aleve), and aspirin; common headache and migraine medications called triptans (Imitrex, Amerge, Relpax). Doctors may prescribe these drugs during pregnancy, however, if the benefits outweigh potential risks to the fetus.
  • Off-Limits: Category X drugs, such as ergotamine derivatives (Cafergot), which might pose a risk to the fetus.
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