Headache In Pregnancy

Clinical description

Headaches are common in reproductive-age women and thus are common in pregnancy.

More than 90% of headaches are migraine headaches or tension-type headaches, but more serious aetiologies should be considered, such as preeclampsia, cerebrovascular haemorrhage or thrombosis, intracranial mass and meningitis.

Signs and symptoms

History Gestational age (consider preeclampsia/eclampsia if gestational age > 20 wks and high BP), triggers, alleviating factors, location, chronic headaches (prior to pregnancy) vs. new onset vs. increased severity, any underlying depression.

Exam Fever (infectious aetiologies), focal vs. generalized neurologic signs Investigations CT or MRI of head if focal neurologic signs, LP Management (depends on aetiology) if no obvious cause,

• Reassurance and bed rest if mild.
• Paracetamol 1000 mg PO 6hourly
• Short course of NSAIDS (< 48 hours)
• Phenergan 25 mg or Metoclopramide 10 mg
• Narcotics if severe (tramadol, codeine or morphine) or not responding to other medications.

The main focus should be on etiology, both pregnancy related (e.g., pre-eclampsia) and non-pregnancy related(e.g., migraine, cerebrovascular causes) before giving medication.