Migraine Headaches in Pregnancy
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Headaches are Common Early in Pregnancy
Though uncomfortable, headaches are common in the first trimester – another side effect of the rising level of pregnancy hormones in your body. For some women, headaches can be a minor annoyance that they must struggle through.
For others, they can turn into painful, debilitating migraine headaches.
Headaches in pregnancy may be related to the hormonal changes taking place in your body, as well as fatigue (common in the first trimester), stress, caffeine deprivation, and dehydration.
Fortunately, for majority of pregnant women, headaches tend to go away in the second trimester, when your hormonal levels tend to stabilize and your body is more accustomed to the pregnancy hormones.
If you have a history of migraine headaches, you may be surprised to find that your migraines actually improve during pregnancy. Roughly two-thirds of migraine sufferers find that their migraines actually improve when they’re expecting. Less than 5 percent of women with a history of these severe headaches claim their migraines worsened in pregnancy, and the rest find no change in their symptoms.
What Causes Migraines?
For women who have never had a migraine headache before, they may experience one for the first time in pregnancy. (Recurrent migraine headaches typically rear their ugly heads around the third trimester.)
An estimated 15 percent of women will experience their first migraine headache during pregnancy – typically in the first 13 weeks of pregnancy. The migraine can be moderate or severe.
The exact cause of pregnancy migraine headaches isn’t completely understood. Experts believe that hormonal changes that occur in pregnancy can trigger migraines. In addition, stress and a lack of sleep can also trigger migraine headaches. Some migraine headaches can last a few others; others can last a full day. Migraines are unpredictable.
Though you can't take any medications (except Tylenol) to treat any headaches or migraines, you can sometimes get relief by rubbing your temples and lying in a dark, cool room.
If you've been sitting in front of the computer for a long period of time, you may want to stand up and take breaks. Eyestrain can make headaches worse. Remember to try to take breaks from the computer screen, and drink plenty of water. Being dehydrated can also elongate headaches.
Some women find that a cold shower offers some quick, albeit temporary relief for migraines. Splashing cold water on your face may also help. If you’re experiencing a tension headache, you may find that a warm shower or bath makes you feel better.
You may also consider keeping a “headache diary,” where you document your headaches and migraines. You will write what you’ve eaten prior to the onset of the headache, what you were doing when it started. This may help you pinpoint what triggered the headache.
Pregnancy Health Section
Migraine Headache Treatment
Most pregnant women with migraine headaches improve as the pregnancy progresses. For immediate treatment of headaches the following is recommended:
- Tylenol (acetaminophen) alone is the first line of treatment.
Headaches that do not respond to Tylenol alone may be relieved with a combination treatments including:
- Tylenol (650 to1000mg) with Reglan (10mg)
- Tylenol with codeine (30 to 60mg)
- Tylenol (325mg) with caffeine (40mg) and butalbital (50mg)
Nonsteroidal antiinflammatory drugs (NSAIDs), such as naproxen or ibuprofen, are a second-line option, and safest in the second trimester. In the first trimester, an association with miscarriage has been suggested and in the third trimester their use is associated with premature closure of the ductus arteriosus (a heart vessel).
Opioids — Opioids (eg, oxycodone, hydromorphone, meperidine, morphine) are a third-tier option.
These drugs should not be used on a chronic basis since they are habit-forming and can contribute to the development of medication overuse. They may also worsen the nausea/vomiting and constipation associated with pregnancy. All opioids have potential for maternal addiction and neonatal withdrawal; thus, they should not be used for prolonged periods of time.
Triptans — For moderate to severe symptoms in patients who do not respond to other drugs, triptans can be considered. Sumatriptan is highly effective in treating migraine headaches. Experience with triptan exposure during pregnancy primarily involves sumatriptan and has been generally reassuring
Drugs to reduce nausea and vomiting — meclizine (25 mg orally), diphenhydramine (25 to 50 mg orally), and promethazine(12.5 to 25 mg orally, per rectum, or intramuscularly) are preferred in pregnancy to relieve nausea and vomiting associated with migraine or migraine therapy.