What if I am pregnant and have a headache?
Headache is a very common complaint, and a very difficult problem to deal with via the internet, or any "call-in" type scenario. The vast majority of headaches in reproductive aged women are going to be benign and self-limited. First, one must clarify what type of headache you have. In clarifying the type of headache, we must be mindful of danger signs that mandate presentation to an emergency room. Some of these might be:
- First time headache. The patient has never had headaches before.
- High intensity headache. Described as the worst headache of a person's life.
- Severe persistent headache which reaches maximal intensity within a few seconds.
- Altered mental status or seizure accompanying the headache.
- Concomitant infection ie sinus infection, fever.
- Visual changes.
- Headache with exertion.
- Patients being followed for high blood pressure especially in the third trimester. May have swelling, visual changes and even abdominal pain.
If the patient has a history of migraines and the headache is typical, then we usually conclude that this is a migraine though many patients will notice an improvement in migraines during pregnancy. Tension headaches are very common during pregnancy. Typically, we recommend Tylenol 1000mg and before 32 weeks gestation, ibuprofen (ie advil,motrin) 800mg. We also recommend drinking a caffeinated beverage such as 12 oz. soda. Though we don't advocate regular caffeine consumption, episodic use is not contraindicated in this situation. We do not recommend using your midrin, or imitrex. If you call the on-call physician, you will likely be told to go to the emergency room for evaluation and pain medications.
Nsaids such as motrin, ibuprofen, advil, naprosyn, and aspirin to name a few have generally been considered safe when taken during pregnancy before 32 weeks gestational age. We encourage caution in the use of nsaids especially during the first trimester. There may be a small association with the use of these agents and the formation of cardiac septal defects and orofacial cleft defects in the newborn.
Patients should take medicines during pregnancy only as a last alternative. Many medicines are considered "safe" when taken during pregnancy, and are described as such here; however, these declarations are usually made via observational studies of populations. They are rarely made as the result of rigorous study. Thus, caution and restraint should be exercised in starting any medication, prescription or over the counter, during pregnancy.