For a Pregnant Woman, when Is a Headache Not Just a Headache?

Pregnancy headache

Everyone gets headaches sometimes. Pregnant women get headaches as often as anyone else. If a pregnant woman is prone to migraine headaches, she still may get them during her pregnancy.

Is It Serious?
In rare cases during pregnancy, a headache may be a symptom of something more serious. But doctors did not have good guidance on when a headache might be due to a complication of pregnancy. Now they do.

Researchers at the Montefiore Health System and Albert Einstein College of Medicine in the Bronx analyzed the medical records of 140 pregnant women who had a severe headache, one bad enough for them to be referred to a neurologist. The women were an average of 29 years old and a little more than half were in their third trimester of pregnancy. Most were Hispanic or African-American, which reflects the community around Montefiore Hospital.

Ninety-one of the women had what is called a primary headache, which means that the headache was not due to some other problem. Most of these women were having a migraine headache, others had tension-type headaches. The other 49 women had a secondary headache, a headache that is caused by another problem. Of these, half were found to have a headache due to high blood pressure; other causes like seizures, bleeding, or tumors were very rare.

Headache and Preeclampsia
But about 40% of women who had a secondary headache had preeclampsia, a serious complication of pregnancy. Preeclampsia (which was once called toxemia) typically occurs during the second or third trimester of pregnancy and may be related to an abnormal interaction of blood vessels that supply the placenta. Symptoms and signs can include high blood pressure, headaches, blurry vision, or abdominal pain, although some patients may have no symptoms.

The researchers, led by Matthew S. Robbins, MD, found that the two most common signs that a headache may be a symptom of something serious were high-blood pressure and having had no prior history of frequent or migraine headaches. A pregnant woman who had a headache and no history of problems with headaches was much more likely to have some other underlying medical problem than a pregnant woman with a headache and a history of migraines, who is more likely to be experiencing a migraine that is more painful or longer-lasting than usual.  Other red flags for underlying problems were seizures and a fever.

Physician Screening
“Our study suggests that physicians should pay close attention when a pregnant woman presents with a severe headache, especially if she has elevated blood pressure or lack of past headache history. Those patients should be referred immediately for neuroimaging and monitoring for preeclampsia,” Dr. Robbins said in a statement.

The women in this study had headaches that were severe and getting worse; bad enough that the women felt they should see a doctor or go to an emergency room. Most pregnant women will not get headaches this severe. But having a guide to help doctors determine when a headache is not just a headache is a boon to pregnant women everywhere.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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