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Headache in pregnant and postpartum women

Men-Jean Lee, MD
Debra Guinn, MD, FACOG
Susan Hickenbottom, MD, MS
Section Editors
Charles J Lockwood, MD, MHCM
Jerry W Swanson, MD, MHPE
Deputy Editor
Vanessa A Barss, MD, FACOG


Headaches are common among women in their childbearing years: in the Norwegian Head-HUNT study, 60 percent of women ≤40 years of age reported experiencing a headache within the previous year [1]. Tension-type headache and migraine are most common, while cluster headache is much less common [2].

For women with a history of headaches, the effect of pregnancy on the frequency and severity of their headaches, the effect of their headaches on pregnancy, and the safety of maternal headache treatment for the fetus are major concerns. When headaches first present during pregnancy or postpartum, a diagnostic evaluation is indicated and should consider the possibility that the headache is related to a complication of pregnancy; severe preeclampsia/eclampsia always needs to be excluded in women over 20 weeks of gestation.

This topic will discuss issues specific to diagnosis and management of headache in pregnant and postpartum women. The diagnosis and treatment of headaches in the general population are reviewed separately. (See "Evaluation of headache in adults" and "Evaluation of the adult with headache in the emergency department".)


In most cases, pregnant women with primary headache syndromes (tension-type headache, migraine headache, cluster headache) have been diagnosed before pregnancy, but as many as 10 percent initially present or are first diagnosed during gestation [3]. Among pregnant women with the onset of new or atypical headache, one third have migraine, one third have preeclampsia/eclampsia-related headache, and the remaining one third have a variety of other causes of headache (table 1) [4,5].

Pregnant women presenting with headache complaints should be evaluated initially with a detailed history and physical examination [6]. A woman with a prior history of headaches may continue to experience them during pregnancy; pursuing a complicated duplication of diagnostic testing is not necessary if her characteristic symptoms have not changed.


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Literature review current through: Sep 2016. | This topic last updated: May 26, 2015.
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