More than 3 billion people around the world have frequent headaches that affect their ability to do daily tasks. Tension headaches are the most common, but migraines cause more problems for women younger than 50.
The most common headaches have the following symptoms:
If you get headaches and you’re planning a pregnancy, the best time to tell your obstetrician–gynecologist (ob-gyn) is during a prepregnancy care checkup. If you didn’t have a prepregnancy care visit before you got pregnant, plan to talk about your headaches as soon as possible. You and your ob-gyn should discuss:
Together you can discuss how you will manage headaches if you get them when you are pregnant or breastfeeding.
Sometimes the headaches people had before pregnancy continue when they are pregnant. These are called primary headaches.
For some people, headaches develop during pregnancy. These are called secondary headaches. They have several causes:
There’s another type of headache that’s caused by preeclampsia, a serious high blood pressure disorder that develops during pregnancy.
If you got headaches before pregnancy, you and your ob-gyn should review the medication you took to prevent them and talk about whether it needs to change. Your ob-gyn may recommend continuing or changing your medication. They may also recommend decreasing or stopping the medication that prevents headaches. This may be true if you get migraines because this type of headache sometimes goes away during pregnancy.
Yes, there are two over-the-counter (OTC) medications that are safe to take during pregnancy.
Acetaminophen. This medication may be taken for all headaches. There are also acetaminophen tablets that have caffeine. This combination has been shown to help with migraine pain. If you take acetaminophen with caffeine during pregnancy, make sure your total caffeine from all sources (including coffee) does not go beyond 200 mg per day.
Nonsteroidal anti-inflammatory drugs (NSAIDs). These OTC medications include ibuprofen and naproxen. They can be taken for migraines that don’t get better with acetaminophen, but only in the second trimester and only for 48 hours or less at a time. It’s not clear if NSAIDs are safe for a fetus during the first trimester. Taking NSAIDs during the third trimester may lead to birth defects.
Talk with your ob-gyn if you plan to take one of these medications. Also let them know if your pain continues or gets worse while taking OTC medication.
There’s a prescription medication called metoclopramide that can be used for headaches that are new in pregnancy, come every day, and cause constant pain. It may be taken as pills or given through an intravenous (IV) line. It may be combined with a medication called diphenhydramine. You and your ob-gyn may talk about whether this medication is right for you.
Acetaminophen, caffeine, and metoclopramide are all safe to take when you are breastfeeding. Most NSAIDs are also safe, but you should avoid aspirin.
Prescription migraine medications called triptans can also be used when you are breastfeeding. Small amounts of triptan medication pass to breast milk. Because of this, your ob-gyn may recommend you not breastfeed for several hours after taking a triptan. Together you can talk about whether this medication is right for you and whether you will need to avoid breastfeeding for a short time after taking it.
Sometimes a bad headache can be a sign of preeclampsia. This is a serious high blood pressure disorder that can affect all the organs in your body. It usually develops after 20 weeks of pregnancy, often in the third trimester. When it develops before 34 weeks of pregnancy, it is called early-onset preeclampsia. It can also develop in the weeks after childbirth.
In addition to a headache that will not go away, symptoms of preeclampsia can include:
If you have a bad headache with any of these symptoms, especially if they develop in the second half of pregnancy or within 6 weeks of giving birth, call your ob-gyn right away.
A thunderclap headache comes on quickly with a lot of pain. It’s often a sign of something serious. There may be pain in the head and down the back of the neck. Some people with a thunderclap headache also have confusion, weakness, loss of vision, or changes in speaking or thinking. If you get a headache like this, go to an emergency room right away.
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