Headache during pregnancy - what can be done if you can’t do much?

26.10.2015
Maltseva Marina Arnoldovna

Head of the consultation department - neurologist, specialist in the field of extrapyramidal pathologies, doctor of the highest category

Headache is a common symptom that occurs during pregnancy. During this period, it is worth paying special attention to your well-being, since the mother’s condition affects the proper development of the fetus. Acute pain can be a consequence of insufficient blood circulation, as well as diseases of internal organs, lifestyle or environmental factors. Experts at the Clinical Brain Institute argue that each case should be examined separately. Although this symptom is often not considered a reason to see a doctor, it can signal dangerous problems. Only a complete diagnosis will allow you to identify disorders in time and begin treatment for headaches.

1. Possible causes of headaches during pregnancy

1.1 In the first trimester

1.2 In the second trimester

1.3 In the last trimester

2. Treatment methods for headaches

Types of headaches

Headache can be an independent disease or a symptom of another pathological condition. Depending on the etiology, the treatment method will be selected. And for pregnant women, the safety of the chosen treatment method for the mother and fetus must be taken into account, since not all drugs are approved.

The international classification distinguishes between primary and secondary types of cephalgia. Separately, cranial, central and facial neuralgia are distinguished, resulting from damage to the nerves innervating the tissues of the face and the rest of the head.

Primary headaches occur due to damage to the blood vessels and nerve pathways of the brain. These include the following types of pathology:

• migraine;
• tension headache;
• cluster headaches and other vegetative types;
• Other types of primary pathology.

Secondary include conditions resulting from systemic diseases, changes in other organs and metabolic disorders. These include:

• consequences of head or neck injuries;
• vascular abnormalities of the skull or neck;
• taking or withdrawing from various substances;
• non-vascular brain abnormalities;
• infectious causes;
• homeostasis disorders;
• injury or disease of the eyes, ears, skull, face, teeth and other structures;
• mental disorders.

Any of these types of cephalgia can occur in early pregnancy or later. Treatment methods may vary and must be selected individually by a neurologist or other specialist.

Why headaches occur during pregnancy: main reasons

Every fifth woman is familiar with cephalalgia (headache) during pregnancy - this is what statistics say. Most often, cephalgia makes itself felt in the first trimester, although some pregnant women suffer from it in later stages. There are many different reasons for headaches - ranging from minor and temporary problems to serious chronic pathologies. Let's try to figure out why a headache may hurt during pregnancy and what needs to be done.

The main causes of headaches during pregnancy are:

• hormonal changes that are absolutely natural for a pregnant woman’s body; at the same time, the level of estrogen and the pregnancy hormone progesterone increases, which affects vascular tone; if the level of estrogen (in particular, estriol) increases beyond normal limits, this can cause vascular spasms, as evidenced by headache and dizziness;
• reaction to atmospheric weather phenomena: during magnetic storms, cloudy weather on the eve of rain or snow, surges in blood pressure may occur; when it sharply decreases or increases, headaches occur;
• heavy loads and fatigue;
• stress or emotional distress;
• hunger or thirst;
• being in stuffy or poorly ventilated areas;
• problems with sleep: this can be either insomnia or too much sleep (more than 10 hours);
• poor posture due to excess body weight, voluminous belly during pregnancy (as a rule, this problem occurs in the later stages);
• consumption of certain products, especially those containing caffeine (strong tea, coffee, large portions of chocolate);
• some conditions and diseases: vegetative-vascular dystonia, viral diseases (influenza, ARVI), toothache, osteochondrosis and other pathologies that occur in the cervical vertebrae.

Causes of headaches in pregnant women

Migraine

The most common cause is migraine. The disease is 2–3 times more common in women than in men. In 80% of pregnant women with migraine that existed before conception, the disease becomes acute. Another 1.5-16% of the disease debuts during pregnancy, which is more common in the first trimester.

Migraine is associated with a specific vascular reaction, as well as hormonal imbalances. High levels of estrogen should protect against pain, but its fluctuations lead to a paradoxical situation. Therefore, pain symptoms are more common in the early stages of the disease. Migraine relief in the second trimester is reported in 50-80% of women.

There is a type of migraine in which the attack is preceded by an aura—visual disturbances of varying severity. Maybe:

• loss of field of vision;
• spots, flickering before the eyes;
• difficulty focusing vision.

Relief of migraine with aura is rare; symptoms remain distinct or may worsen.

Tension headache

Tension headaches (TTH) are rare in pregnant women. It is provoked by the following factors:

• eye strain or fatigue;
• prolonged uncomfortable posture, tension in the muscles of the neck and shoulder girdle;
• sleep disturbance;
• stressful conditions, nervous overload.

TTH is not accompanied by an aura and is not aggravated by sharp sounds or bright lights, which is different from migraine. However, this condition can develop into a chronic form. If there are more than 15 days with cephalalgia in a month, it is considered chronic.

Preeclampsia

Frequent headaches may be associated with high blood pressure during pregnancy. Symptoms that appear after 20 weeks, accompanied by swelling and protein in the urine, indicate gestosis. This condition is dangerous for pregnant women, leading to the development of placental insufficiency and intrauterine growth retardation. With gestosis, there is a high risk of placental abruption and damage to the mother’s liver with the development of dysfunction. A severe form of gestosis, accompanied by pain, can lead to coma.

Infectious, mental illnesses, injuries

Severe headache also occurs as a symptom of poisoning in infectious diseases. Acute fever, acute otitis media, sinusitis and meningitis pose different risks to mother and baby. But the relief of these diseases is carried out according to general rules.

Painful conditions resulting from previous head injuries may also become worse. Mental illness rarely begins during childbirth, but may worsen after childbirth, often accompanied by headaches.

Migraine

With migraine, the headache is usually pulsating in nature and unilateral, predominantly frontotemporal, with irradiation of pain to the eyes on the side of the pain, although there are cases of bilateral localization.
The intensity of the headache is very pronounced. Such a headache takes a woman away from her daily activities, forces her to lie down with her head in the pillow and not move, since any movement intensifies the headache. Another characteristic symptom of migraine is increased sensitivity to sound and light, combined with sweating, palpitations and nausea, and sometimes vomiting. Sometimes a migraine attack can be preceded by dizziness, the sensation of strange smells and even visual disturbances (zigzags, sparkling dots, sparks from the eyes). However, approximately seven out of ten women note that headaches during pregnancy either regress completely or bother them significantly less, and are easier in the second and third trimester, which is associated with changes in the level of estrogen in the hormonal system of a pregnant woman. However, one in ten women report worsening headache symptoms during pregnancy. After childbirth, in most women, migraines return to their previous course. In addition, migraines have certain provocateurs: imbalance of estrogen levels, bright light, sound, lack of sleep, oversleeping, stress, hunger, red wine, etc.

What symptoms should you pay attention to?

Cephalgia is not the only symptom you should pay attention to. The choice of acceptable remedies for headaches is possible only taking into account additional symptoms and causes of ailments.

The following combinations of symptoms are dangerous:

• gradually increasing swelling of the legs, arms and face;
• high blood pressure;
• flickering before the eyes;
• shortness of breath;
• tingling in the right hypochondrium;
• nausea, vomiting;
• confusion, dizziness.

This combination may indicate severe gestosis, its atypical form or preeclampsia. This condition is dangerous for pregnant women and requires urgent hospitalization in the intensive care unit, as there is a possibility of loss of consciousness and the development of coma.

The following symptoms are typical for a migraine attack:

• one-sided pulsation in the head;
• accompanied by nausea, vomiting;
• may be combined with photophobia, fear of sound.

The attack, which can last for different periods of time, is accompanied by a period of drowsiness and lethargy.

Hormonal changes during pregnancy can lead to activation of brain tumor growth. This is accompanied by the appearance of chronic pain syndrome. Additional symptoms include visual disturbances and lack of response to medications when trying to relieve symptoms. Therefore, if the pills do not help, you need to consult a doctor and get tested.

Pain syndrome is a frequent companion to infectious diseases. A cold causes fever, chills, runny nose and cough. However, some infections are dangerous for a pregnant woman. A doctor's help is necessary if the headache is unbearable, a rash appears on the skin, and there are no catarrhal symptoms.

When is it necessary to consult a doctor?

It is necessary to consult a specialist and undergo diagnostic examinations if:

• sudden onset of severe headaches, their intensification and frequency;
• the appearance or intensification of pain during physical activity;
• the occurrence of additional symptoms - nausea, vomiting, difficulty swallowing, high temperature, increased blood pressure, pulsating tinnitus, increased urination, swelling, numbness of the limbs or face, visual or speech disturbances, lethargy, confusion.

Treatment methods depending on the cause

The list of drugs that can be taken by pregnant women for headaches is limited due to their effect on fetal development and the state of the fetoplacental complex. Pregnant women are recommended to use preventive measures to avoid discomfort. If the pain syndrome is not accompanied by additional symptoms of pathology, it can be assumed that it is associated with overwork or overexertion. Doctors recommend following general recommendations:

• control the amount of liquid you drink, during hot periods at least 1.5 liters per day;
• refrain from watching TV or working on the computer;
• rest lying down;
• take a walk in the fresh air;
• do simple exercises;
• Eliminate tea and coffee from your meals.

Non-steroidal anti-inflammatory drugs help in the fight against headaches. Pregnant women can use Paracetamol and Ibuprofen in minimal daily doses. But you need to take pills only when unpleasant symptoms appear; prophylactic use is not allowed. Caution is observed from 32 weeks of pregnancy and older. Ibuprofen and its analogues accelerate cervical ripening by affecting the synthesis of prostaglandins. Therefore, for pregnant women at risk of premature birth, such treatment may be dangerous.

Paracetamol is the drug of choice for headaches in pregnant women.

No-spa is an antispasmodic. Effective for headaches caused by excessive stress. Nostropa is prescribed at each stage of pregnancy.

For mild discomfort, acupressure may help relieve symptoms. It is used at all stages of pregnancy without the risk of negative effects on the fetus. The essence of this technique is to stimulate certain nerve points on the surface of the skull. Hot spots are located in the following areas:

• between the eyebrows on the bridge of the nose;
• on the cheekbone along the pupil line;
• at the base of the skull, between the muscles;
• where the spine enters the skull.

The point that helps cure headaches is also in the hand. However, its massage is prohibited for pregnant women due to the risk of premature birth.

You can get rid of unpleasant sensations without pills using breathing exercises, yoga, and psychotherapy methods. In the latter case, some experts suggest the combined effect of special sounds or light waves.

Migraine

Treatment of migraine during pregnancy is aimed at stopping an acute attack and preventing its recurrence. Therapeutic and non-therapeutic methods are used. Efficiency increases if provoking factors can be identified, which are often specific foods, emotional states, and weather.

Pain management techniques are recommended and can be taught by a neurologist or psychotherapist. Sessions are also scheduled:

• acupuncture;
• psychotherapy;
• transcranial electrical stimulation;
• physiotherapy;
• massage or chiropractic care.

Massage and manual therapy should be used with caution. They are recommended only in early pregnancy.

Drug therapy is carried out depending on the frequency, duration and intensity of migraine attacks. Prophylactic use of tablets in the first trimester of pregnancy and from the 38th week of pregnancy, shortly before childbirth, is not recommended. But if the pain is unbearable, it can be relieved with approved medications.

What pills can you take without worrying about the development of the fetus? These:

• Paracetamol is the drug of choice for pregnant women;
• Ibuprofen - allowed in the 1st-2nd trimester and prohibited in the 3rd trimester;
• Aspirin - can only be used if other medications are ineffective, not recommended in the late period;
• Caffeine - can be consumed throughout pregnancy;
• Naproxen - allowed in the 1st-2nd trimester of pregnancy;
• Summatriptan is the most studied drug for migraine, safe for pregnant women at any stage, and does not have a teratogenic effect on the fetus;
• Naratriptan - can be used to relieve an acute attack of migraine;
• Metoclopramide - effective for migraines during pregnancy, necessary when headaches are accompanied by nausea;
• Prednisolone - used in pregnant women when painkillers and antispasmodics are ineffective.

In case of severe prolonged attacks, intravenous injections of prochlorperazine and its combination with magnesium sulfate are used.

Drugs for the prevention of migraine in pregnant women

Preventive treatment in pregnant women is carried out in the following cases:

• high frequency of attacks - more than 2 times a week;
• severe and prolonged attacks;
• maladjustment and decreased ability to work;
• dehydration and malabsorption of nutrients;
• Insufficient effect when using painkillers during an acute attack.

Other medications are used to prevent migraines. Low doses of propranolol can be used in pregnant women prone to high blood pressure. However, it is not recommended if you are prone to arterial hypotension, bronchial asthma and in the late period 1-2 weeks before the expected date of birth. It is also safe to use to reduce migraine attacks:

• Fluoxetine;
• Magnesium sulfate;
• vitamin B 2.

Preferably complex treatment, which uses a combination of several agents with multidirectional effects. A pregnant woman suffering from migraine should be examined by a neurologist.

Preeclampsia and hypertension

Preeclampsia and hypertension are the second most common causes of cephalalgia. This condition is dangerous, so self-medication is excluded. The disease debuts in the second trimester of pregnancy. Hospitalization is required for moderate and severe forms of gestosis. In some cases, arterial hypertension is an indication for hospitalization.

Treatment is carried out comprehensively. It is designed to prevent pressure surges and the occurrence of cephalalgia. A diet low in salt, animal fats and calories is recommended. Body weight is carefully controlled.

Tablets for headaches during pregnancy associated with arterial hypertension are selected individually. A woman takes them every day to avoid sudden surges in blood pressure and associated serious complications. The following drugs are approved for use by pregnant women:

• Methyldopa;
• Nifedipine;
• Metaprolol.

Diuretics, especially spironolactone, are dangerous for lowering blood pressure. The use of angiotensin-converting enzyme inhibitors, calcium antagonists Diltiazem and Felodipine and some other drugs is prohibited. They are teratogens, can disrupt ion exchange and cause complications during pregnancy.

Drugs for sudden surges in blood pressure allowed during pregnancy

Sometimes headaches are associated with the risk of blood clots due to hypercoagulability. This condition often occurs in women with arterial hypertension or in the early stages of preeclampsia. To reduce the risk of thrombosis, pregnant women are prescribed aspirin in a minimal dose, and in case of severe hypercoagulability, low molecular weight heparin.

Infection

The infection leads to secondary headaches. As for the treatment of the underlying disease, it should be prescribed by a doctor depending on the clinical symptoms. In infectious and inflammatory diseases, headache is a consequence of poisoning. Therefore, pregnant women are prescribed non-steroidal anti-inflammatory drugs to reduce the severity of the inflammatory reaction, lower body temperature and relieve discomfort.

If the headache is associated with acute respiratory infections, treatment is carried out with nonspecific measures. Antiviral drugs are not prescribed to pregnant women. Only in case of bacterial infection is it necessary to use broad-spectrum antibiotics. Women with pneumonia and other severe infections are detoxified by intravenous infusion of special solutions. This will reduce headaches and speed up recovery.

Antibiotics for pregnant women –

Very common questions that one hears are: 1) can pregnant women take antibiotics, 2) what antibiotics can pregnant women take?
In this case, the first drugs of choice are the so-called “beta-lactam antibiotics” (for example, the penicillin group), which include amoxicillin or Amoxiclav. Next come the cephalosporin antibiotics, as well as the lincosamide antibiotic such as Clindomycin. Antibiotics from the following groups are prohibited: tetracyclines and fluoroquinolones. With caution (not advisable, but in some cases possible) - sulfonamides and some representatives of aminoglycosides. Before starting antibiotics, it is best to discuss this with your obstetrician-gynecologist. In table No. 1 you will see a list of the safest antibiotics (safety category “B”).

Preventive measures

Headaches cannot always be prevented. But pregnant women are advised to follow certain rules to reduce the risk of exacerbation of migraines and other diseases with cephalgia:

1. Drink enough fluids; symptoms worsen if dehydrated.
2. Do special exercises for pregnant women, as well as yoga, and do breathing exercises.
3. If you are prone to migraines, drink black or green tea.
4. Follow a daily routine, get more rest.
5. At the first sign of a migraine, try to lie down to rest or sleep.

It is necessary to avoid stressful situations at home and at work. No overtime or night shifts. Find time during the day to get enough rest or a short nap. It is also recommended to limit the time spent at the computer, refrain from working in uncomfortable positions, and also walk more in the fresh air.