Why is Headache Important During Pregnancy?

Although headache is a common problem, the pain that occurs during pregnancy or immediately after childbirth needs to be examined more carefully. Obstetrics and Gynecology Specialist Op. Dr. Tanju Demiroren points out that the severity and frequency of pain may vary depending on the underlying problem.

Headache is one of the most common complaints, especially in women of childbearing age. A study conducted in Norway revealed that 60 percent of women under the age of 40 had headache complaints last year. Especially the occurrence of pain during and after pregnancy is of particular importance for both maternal and infant health. Indicating that a study conducted in 2015 found that in 35 percent of pregnant women who applied to the emergency unit with a headache, the headache was due to a secondary disease (pregnancy-induced hypertension), Yeditepe University Hospitals Gynecology and Obstetrics Specialist Op. Dr. Tanju Demirören said that especially the newly emerging headache during pregnancy or after childbirth should be studied in detail for this reason. “The first sign of high blood pressure of pregnancy (preeclampsia) and convulsions associated with this condition (eclampsia) can be manifested in the headache that occurs after the 20th week of pregnancy and within two weeks after childbirth,” he remarked.

Toxemia during Pregnancy is the Leading Cause

Explaining that if there is an atypical or newly emerging headache after the 20th week of pregnancy, even if the person's blood pressure is normal, toxemia of pregnancy (preeclampsia) should come to mind, Op. Dr. Tanju Demirören gave the following information: "In the evaluations carried out, preeclampsia was detected in about one-third of these cases. The pains in this group are usually widespread, constant, moderate to severe, and throbbing. Blurred vision, light sensitivity, and changes in the level of consciousness can also be observed alongside it. Similar signs are also observed in the headache due to migraine. However, the pain in migraine is often unilateral. Here, the diagnosis is made by taking into account the systemic examination, blood pressure values, and eye examination signs. However, neurological assessment is also crucial in a pregnant woman's headache. Neurological examination results are normal as long as there is no brain hemorrhage in the headache caused by preeclampsia.”

If These Symptoms Are Present Together With a Headache, Pay Attention!

Op. Dr. Tanju Demirören listed the symptoms that suggest the presence of severe underlying disease in a pregnant woman with a headache as follows: “In case of confusion along with headache, convulsions, papilledema, neck stiffness along with neurological signs, very severe onset of pain, the occurrence of migraine-like pain for the first time or its occurrence with different severity and in different from than the previously existing pain, the fact that pain is severe enough to wake up and that painkillers do not alleviate the pain a doctor should be consulted immediately.”
Drawing attention to the importance of detailed examination of the pregnant woman who applies these complaints in terms of accurate diagnosis, Op. Dr. Tanju Demirören said, “In pregnant women who are known to have tension-type, migraine, or cluster headache before pregnancy, there is no need to take any further action after preeclampsia is ruled out if the symptoms are compatible with the pain picture previously observed. Here, one should be careful because detecting high blood pressure together with headache during pregnancy may be dangerous.”

Migraine is The Most Common One

Explaining that while migraine-type pains are detected in two-thirds of pregnant women who apply to the doctor with a headache, another underlying disease (gestational hypertension, preeclampsia, etc.) is observed in a third of them, Op. Dr. Tanju Demirören explained which diseases manifest themselves with which symptoms as follows: “Pregnant women with migraine-type, tension-type or cluster-type headaches are usually diagnosed before pregnancy. It has been observed that after excluding pregnancy-induced hypertension, half of the headaches that are atypical or occur first during pregnancy are migraine-type, and the rest are tension-type or cluster-type. Of Migraine Headaches, 70 Percent Are Unilateral. While 30 percent are felt either in both frontal lobes or the entire head in a widespread form. It increases with routine physical activity, starts at moderate and severe intensity, gets increasingly severe, and is throbbing. The patient escapes into a dark, silent environment. It lasts from 4 to 72 hours. Nausea, vomiting, photosensitivity, intolerance to sound, and usually preliminary visual signs are present. Sometimes, they can be accompanied by sensory or motor loss. A decrease in the frequency of pain is observed in 60-70 percent of those who have migraine during pregnancy. However, an increase is observed in the postpartum period. Migraine attacks do not have an adverse effect on pregnancy.”

Differences between Tension- And Cluster-Type Pain

Another pain group diagnosed before pregnancy consists of tension- and cluster-type headaches. Op. Dr. Tanju Demirören gave the following information on the distinctive characteristics of both types: "Tension-type pain is bilateral. It increases and decreases in case of feeling stress or pressure. The patient is active or sometimes wants to rest. It may last from 30 minutes to 7 days. There are no other accompanying symptoms. Cluster-type pains are always unilateral, usually starting around the eyes or temples. The pain starts rapidly, intensifies within minutes, and is in a deep, constant, excruciating, and explosive form. The patient is active. The pain lasts from 15 minutes to 3 hours. On the same side, watering of the eye, redness, nasal congestion, runny nose, drooping eyelid, pupil shrinking, fatigue, or agitation may occur.”

Treatment Is Shaped Based on the Type of Pain

Neurological imaging (MRI) should be used more often in clinical discrimination of headaches with a sudden and severe onset without any previous headache history. In a pregnant woman applied with a headache, after ruling out the risk of gestational hypertension or eclampsia (a picture progressing with contractions due to gestational blood pressure) through necessary laboratory and clinical examinations, treatment is arranged according to medications that can be used during pregnancy and the type of pain.”

This content was prepared by Yeditepe University Hospitals Medical Editorial Board.

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