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When Should You Worry About Headaches During Pregnancy? OB-GYNs Explain

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Nausea. Fatigue. Hormonal acne. Pregnancy is a wonderful thing, but it comes with some not-so-nice symptoms that can make it a little less blissful along the way. For some women, headaches can seem to pop up out of nowhere. They're usually just another normal symptom, but when are headaches during pregnancy something to worry about?

Heather Levin, MD, board-certified OB-GYN and maternal fetal medicine specialist at Northwell Health, tells Romper in an interview that whether headaches are normal or new for you, it’s important to bring them up with your doctor. They can help determine how serious the problem is. “Headaches during pregnancy should always be discussed with your doctor. Headaches that are mild or self-limiting are generally of less concern than severe, persistent headaches,” she explains.

“Headaches are very common, particularly in the first trimester of pregnancy. Commonly, first trimester headaches tend to be either migraines or tension headaches. The cause for this early pregnancy increase isn’t always clear but is likely multifactorial, due to the rapid change in hormones of early pregnancy, nausea and dehydration, stress and poor sleep, and dietary changes, like a decrease in caffeine intake,” Peter Kim, MD, an OB-GYN at SCL Health Central Park OB-GYN tells Romper.

Some women do experience headaches more frequently than usual when they get pregnant. The cause for those headaches, however, can change depending on the trimester. Headaches that arise in the third trimester are the ones docs would be most worried about, as they can be a sign of something serious.

“Headaches in the first trimester can be caused by changes in caffeine intake or oral food intake, especially if a patient is suffering from severe nausea or vomiting,” says Levin. “Headaches in the second trimester can often be due to physiologically normal, but lower blood pressure. Headaches in the third trimester are always concerning for pre-eclampsia, a severe blood pressure disorder.”

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Kim says pre-eclampsia headaches may be related to swelling in the brain or constriction of blood vessels. Also, he adds that having headaches during pre-eclampsia can mean you’re at risk for extra complications.

“After 20 to 23 weeks of pregnancy, the most common thing we consider and rule out is the possibility that the headache is from the condition of pre-eclampsia which, in general terms, is a rise in blood pressure leading to a host of pregnancy complications,” he says. “Headache is a harbinger of risk for further complications such as seizures and stroke. I find that visual changes such as seeing spots or lights, tunnel vision, and blurriness are particularly worrisome for seizure risk.”

For women who experience migraines regularly, Kim actually finds that pregnancy seems to give them a bit of a break.

“My experience has been that, while I often will see women with their first ever migraine headache in early pregnancy, most frequent migraineurs actually find that their headache frequency decreases in the second and third trimester by 70% or more. Unfortunately, about half of women with frequent migraines will then experience a rebound migraine in the first month postpartum,” he says.

If you experience headaches or migraines normally, it’s important to share that information with your OB-GYN at your first prenatal appointment. This can help them ensure you’re healthy moving forward, and manage your pain safely for you and your baby. You can expect lots of follow-up questions.

Kim says when doctors evaluate headache complaints, they direct their questions toward ruling out the concerning reasons for a headache, like meningitis, stroke or blood clot events, aneurysms, or tumors. “I like to know the severity of the headache compared to past experiences. Statements like, ‘This is the worst headache of my life,’ catch my attention," he says. "Other concerning signs are mental status changes or confusion, waking up in the middle of the night because of the headache, no improvement at all with over-the-counter medications, stiff neck, and fever.”

Sources:

Heather Levin, MD, board-certified OB-GYN and maternal fetal medicine specialist at Northwell Health

Peter Kim, MD, an OB-GYN at SCL Health Central Park OB-GYN