How to handle pregnancy headaches safely

Headaches are one of the commonest complaints of pregnancy. Most are harmless and ease with simple care. A few are a warning sign, and knowing the difference matters.

In the first trimester, headaches are often linked to rising hormones, a bigger blood volume, nausea, poor sleep and cutting down on coffee. Later on, tiredness, tense shoulders, posture and long days are more likely triggers. Low blood sugar from skipped meals and dehydration in Malaysian heat play a part throughout.

Many women with migraine find attacks ease in the second and third trimesters. Others notice no change, or get their first migraine in pregnancy.

Types of headache in pregnancy

Most headaches in pregnancy are primary headaches. The headache is the problem itself, rather than a sign of another illness. Tension headaches and migraines are the two you are most likely to meet.

Tension headache

This feels like a tight band or pressure around the forehead, temples or the back of the head, often on both sides. It is linked to tight neck and shoulder muscles, stress, tiredness and long hours at a screen.

A warm shower, a warm or cool compress on your neck or forehead, gentle stretching and a rest in a quiet room often help.

Migraine

A migraine is usually a throbbing pain, often on one side, with nausea and sensitivity to light and noise. Some people see flashing lights or zigzag lines first, called an aura. An attack can last hours or even a couple of days.

Lie down in a dark, quiet room, put a cold pack wrapped in a cloth on your forehead for 15 minutes at a time, and sip water. If you had migraines before pregnancy and took regular medicine for them, ask your doctor which treatments suit pregnancy before you need them.

Other headaches

Cluster headaches, with severe pain around one eye, and headaches that wake you at night are less common. Tell your doctor about any new type of headache you have not had before.

What is safe to take

Paracetamol is the usual first choice for headaches in pregnancy. Take it at the dose on the pack, for the shortest time you need it.

Avoid ibuprofen, other anti-inflammatory painkillers and aspirin unless your doctor prescribes them. Some doctors do prescribe low-dose aspirin in pregnancy for other reasons, which is different from taking it for a headache. Check with your doctor or pharmacist before taking any migraine medicine, herbal remedy or headache powder. Tell them how many weeks pregnant you are.

Preventing headaches

• Eat little and often. Long gaps between meals bring on headaches. Keep crackers, fruit or nuts in your bag.
• Drink plenty of water. Carry a bottle, especially on hot days and if you are vomiting.
• Keep regular sleep. Go to bed and get up at similar times, and rest when you can.
• Cut caffeine down slowly. Stopping suddenly can cause withdrawal headaches. Stay under 200 mg a day.
• Move gently every day. A walk, prenatal yoga or stretching eases tense muscles.
• Mind your posture. Take breaks from the screen and roll your shoulders often.
• Manage stress. Talk to someone, read, pray, or simply sit quietly for ten minutes.
• Notice your triggers. A headache diary can show patterns such as certain foods, smells, missed meals or bright light.
• Avoid smoke. Smoking and vaping are harmful in pregnancy, and secondhand smoke can trigger headaches too.

When to worry about a headache

From 20 weeks of pregnancy, a severe headache can be a sign of pre-eclampsia. This condition raises blood pressure and can be dangerous for you and your baby. It needs to be checked quickly.

Go to your nearest hospital the same day, or call 999, if a headache comes with any of these:

• Blurred vision, flashing lights or spots in front of your eyes
• Sudden swelling of your face, hands or feet
• Pain just below your ribs, especially on the right
• Vomiting later in pregnancy
• Feeling very unwell, confused or drowsy

Also see a doctor promptly for a headache that is sudden and severe, the worst you have ever had, does not ease with paracetamol and rest, or comes with fever, a stiff neck, fainting, weakness or difficulty speaking.

Keep your antenatal appointments. Your blood pressure and urine are checked at each visit for exactly this reason. If you have a home blood pressure monitor and your reading is 140/90 or higher, call your clinic.

Looking after yourself

Most pregnancy headaches settle with food, water, rest and a quiet room. Be kind to yourself on the bad days. Ask your partner or family to take on the cooking or the school run, and lie down when your body tells you to.