Headache in pregnant and postpartum women
- Men-Jean Lee, MD
Men-Jean Lee, MD
- Associate Professor
- University of Hawaii
- Debra Guinn, MD, FACOG
Debra Guinn, MD, FACOG
- Director, Montana Perinatal Center
- Director of Obstetrics and Maternal Fetal Medicine
- Kalispell Regional Medical Center
- Susan Hickenbottom, MD, MS
Susan Hickenbottom, MD, MS
- Adjunct Associate Professor of Neurology
- University of Michigan
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Jerry W Swanson, MD, MHPE
Jerry W Swanson, MD, MHPE
- Section Editor — Headache
- Professor of Neurology
- Mayo Clinic College of Medicine
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 . Tension-type headache and migraine are most common, while cluster headache is much less common .
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 . 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 . 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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- GENERAL APPROACH
- COURSE AND MANAGEMENT OF PRIMARY HEADACHE SYNDROMES IN PREGNANCY
- - Treatment of acute migraine
- Acetaminophen alone or combination therapy
- NSAIDs and aspirin
- Drugs to reduce nausea and vomiting
- Other drugs
- Nonpharmacologic therapies
- - Treatment of refractory migraine
- - Prophylactic treatment
- Tension-type headache
- - Treatment of tension-type headaches
- Medication overuse headache
- Cluster headache
- - Treatment of cluster headaches
- POSTPARTUM HEADACHE
- EVALUATION FOR PREECLAMPSIA
- Management of preeclampsia/eclampsia
- SUMMARY AND RECOMMENDATIONS