Health-care professionals must be aware of rarer causes of headaches in pregnancy

Most headaches in pregnancy and the postnatal period are benign, but healthcare professionals must be alert to the rarer and more severe causes of headaches, suggests a new review published today (23 May) in The Obstetrician & Gynaecologist (TOG).

The review looks at common causes for headaches during pregnancy and the postnatal period, possible conditions that may be associated with headaches and how healthcare professionals should manage the care of the woman appropriately.

There are 85 different types of headache. Approximately 90% of headaches in pregnancy are migraine or tension-type headaches. However, pregnancy can lead to an increased risk of certain secondary headaches, a headache caused by an underlying health condition, states the review.

The review states that most headaches in pregnancy are benign but in some cases can be more serious. According to the Confidential Enquiries into Maternal Deaths in the United Kingdom 2006 – 2008 report, neurological conditions were the third most common cause of death, considering both direct and indirect causes. The authors of the review therefore emphasise the need for all medical staff to be well trained to take a full history and examination, make a provisional differential diagnosis and know when to seek neurological expertise.

Migraine is a common form of headache; the condition is more common in women, with the highest prevalence rates during the childbearing years. The review states that pregnancy leads to a reduction in the frequency and severity of attacks of migraines without aura, also known as a common migraine. However, women who do experience migraines have a more than two-fold increased risk of pre-eclampsia than those who do not. Women therefore need to be aware to consult a healthcare professional if their headache is different from their usual migraine, highlights the review.

Another condition associated with a headache in pregnancy is idiopathic intracranial hypertension, a build up of high pressure inside the skull, a rare condition but more prevalent in obese women of childbearing age. The condition may present for the first time in pregnancy and pre-existing disease tends to worsen in pregnancy. It can be fatal if it is not treated promptly as a medical emergency.

I'm pregnant and I'm having terrible headaches. Is this normal? It's not unusual to get headaches when you're pregnant, especially in the first trimester. And if you've always been susceptible to headaches, pregnancy can make them worse.

We don't know exactly why being pregnant makes your head ache. It's probably due to the hormonal free-for-all your body is undergoing, and changes in the way your blood circulates.

Your headaches may always appear on a certain area of your head, or you may get them in different places. They may cause a sharp throbbing pain, or a dull general ache. Headaches don't cause other symptoms.