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When Is A Headache Too Severe During Pregnancy? An OB-GYN Responds

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I am a migraine sufferer. I've had them for almost 20 years. It's one of those facts of my life that I hate, but have learned to accept. Therefore, I have a tendency to slough off any concern that may arise over my own head pain, save for when I was pregnant. Because of my natural state of anxiety, I worried over every pain, tingle, and tickle during those nine months, but that's equally unhelpful. When is a headache too severe during pregnancy, and when is it just any old headache? Pregnant women have enough on their plate as it is without adding an additional layer of worry, but headaches can be scary.

Headaches are also one of the most common complaints of pregnancy, with a majority of patients noting their experience with the pain at some point in the pregnancy, according to Clinical Obstetrics and Gynecology. Most of these headaches are what is referred to as a primary headache. They are typically benign and caused by tension, hormones, stress, or are related to a previously diagnosed migraine condition. However, according to The Obstetrician and Gynaecologist, some headaches are a cause for concern. These secondary headaches can be dangerous. Caused by underlying issues like hypertension, blood clot, or intracranial pressure, these headaches are usually severe, and can be accompanied by nausea, tingling or numbness in the extremities, loss of vision or hearing, or it comes on suddenly with a thunderclap sensation in the head.

Most migraine sufferers I know can spot one coming a mile away. For me, I get auras that creep around the edges of my vision, followed by a buzzing sensation above my ear on whichever side of my brain is going to try to exit my skull, and my stomach? Lurches. I know that I have a 15-minute window to chug a huge coffee and take my medication before I lose all hope of being even moderately functional for the next several hours.

When I was pregnant, I was shocked to realize that the time between the onset of symptoms and the oncoming pain was drastically diminished. I was also scared. That first headache sent me through the paces. The nausea was worse, the headache came fast and furious, and it lasted for hours longer than it normally would. My OB-GYN assured me it was likely due to the surge of hormones, and that appeased my anxiety, but I don't want anyone to stress out the way I did, if I can help it.

So I asked obstetrician and adorable puppy mom, Dr. Teuta Shemshedini when you should worry about a headache during pregnancy. She tells Romper, "First thing to do is notify your doctor about anything that could be considered 'life threatening' such as the first worst headache of your life," which she notes may be an aneurysm. "Headache with loss of ability to see, move or speak," which are symptoms of stroke, "or if headaches are associated with loss of consciousness." All of these are those "red flag" headaches that need to be addressed right away.

Shemshedini went on to tell Romper that "if you have a headache in pregnancy, and are greater than 20 weeks pregnant, the most worrisome diagnosis would be pre-eclampsia. Pre-eclampsia is a pregnancy-specific condition characterized by new onset hypertension and end organ dysfunction with or without protein in the urine." However, if it's before 20 weeks, she notes that it's treatable with acetaminophen, but if it persists, it needs to be addressed by your provider or at an emergency department.

Unfortunately, Shemshedini remarks, the main treatment for pre-eclampsia is delivery because it is life threatening to mother and child. She notes, "If it’s a persistent headache that is unrelieved with acetaminophen and has vision changes or abdominal pain or loss of vision, that is more likely to be pre-eclampsia and a doctor should be notified immediately."

Headaches can be scary, but they're not always dangerous — mostly just annoying. If you're ever concerned, call your provider — it's why they're there. Otherwise, I suggest a blanket fort and cold compresses on your neck. It helps me.

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