Who is prone to headaches during pregnancy?

Women who had headaches before pregnancy! Non-pregnant women with headaches become pregnant women with headaches. Less than 10% of women will have their very first headache during pregnancy.

What is the most common type of headache?

Tension type headaches. And here’s some good or bad news, depending on if you suffer: this type of headache won’t change with pregnancy.

These headaches also won’t adversely affect pregnancy outcomes.

But they are annoying!

And painful!

And can interfere with your daily happiness. 

And I want to make your pregnancy happier, so here are some treatment tips that can help!

First, let’s address non-pharmacologic therapies.

My pregnant patients are interested in these possible treatments because they’re looking to minimize medications if possible.

• Avoid triggering activities! When you have a headache, pause and think about what has happened in the last few hours. Staring at a computer screen? A stressful conversation? A fight with someone? Crappy nights’ sleep? No exercise? No stretching? Poor diet? Dehydrated? Take note and see if you can find the trigger, then avoid it!

• Magnesium. Neurologists I have worked with swear by magnesium supplementation. They prescribe magnesium oxide 300mg three times daily to patient with chronic headaches. It probably doesn’t matter what type of magnesium you use (magnesium oxide, magnesium citrate, etc). It probably doesn’t matter what vehicle you use either (power, pill, liquid).  One side effect? Its laxative effect. Sometimes this is a welcome aid to pregnant patients with constipation. Sometimes it’s a bit too much. If you get diarrhea, use less and taper yourself up as needed.

• Acupuncture. In studies, acupuncture was better than placebo pill at helping treat headaches. But  … it was no different than sham needle punctures. How can this be explained? The authors theorized that the contextual features of acupuncture – the ritual, the relaxation and rest, the physical contact – can be effective. More so than just popping a pill and trying to go about your day.

• Massage. Who needs an excuse for a relaxing prenatal massage? You do! Your masseuse should accommodate your changing body (you shouldn’t be asked to lie flat on your back or your stomach if you are more than 15-20 weeks pregnant). If not, it may be a sign they aren’t used to working on pregnant women. Find a new one.

• Massage DIY. I have a few recommendations for at home help: The first is an S shaped back massager (I used and loved the Original Backnobber). It can help with those knots in your upper back. You direct the movement yourself so you’re guaranteed to get it right. thisworks in transit muscle therapy is magical. This is a must have from my favorite make up artist, Lisa Eldridge (seriously, watch her YouTube videos!). It’s a rollerball massager with essential oils. Yes, pregnancy is a time to splurge on something like this.

• Essential oils: Eucalyptus, Peppermint, Roman Chamomile, Lavender, and Helichrysum oils are thought to help relieve headaches. Essential oils can be used in a variety of ways: diffused into the air or simply inhaling the scent from a few drops placed in your hands. Some oils are used topically and rubbed into the skin. Try the “headache halo” – a dab of oil around the top circumference of the head, where a crown would be placed. The oils feel like a halo above the head, pulling the headache away and into the ether. Different preparations have different qualities, so ask an expert at your naturopathic store for some guidance.

• Physical therapy or psychotherapy

• Maintaining a regular meal / sleep / rest schedule can help in and of itself. Easier said than done, I know! But seriously – one of the most important things you can do!

Now, let’s briefly discuss medications:

Important when using medications in general but particularly important in pregnancy: limit the number and dose of medications you use. Use what works for you and no more. Give each medication the old college try before changing abruptly to a different course.

Every medication label seems to have a warning about use in pregnancy, which is sometimes legit but sometimes just an unnecessary legal disclaimer. Your doctor should give you a list of medications that are safe to take for headaches / pain in pregnancy. Ask her about any medication not on that list (and about the tips I’m mentioning here).

Over the counter medications:

• Tylenol. The generic is acetaminophen. The brand name is easier to remember so I say Tylenol, but I always buy generic. This is first line.

• Caffeine isn’t always considered a medication, but if Tylenol isn’t helping sufficiently, try a bit of caffeine with the Tylenol. Less than 200mg of caffeine daily is usually considered safe for a young, healthy woman with an uncomplicated pregnancy.

• Avoid NSAIDS (non-steroidal anti-inflammatory drugs) like Motrin, Advil, and Aleve. In early pregnancy they may increase your risk for a miscarriage. Later in pregnancy they can interrupt normal fetal blood circulation.

Prescription medications:

These will be monitored by your doctor because they have to prescribe it to you! I usually resort to these medications during pregnancy when over the counter meds aren’t working and only after going over the risks and benefits with my patient.

Narcotic meds, such as Norco or Tylenol #3, can work wonders for some people. They can also make you drowsy or nauseous, which isn’t a winning combination for people who already feel fatigue and nausea as their baseline during pregnancy. There may be a small increased risk for a baby with a heart defect when taken early in pregnancy.  Your baby may have withdrawal symptoms if you take narcotics chronically close to delivery. Like I said, it’s a risks / benefits analysis.

Now get away from your computer screen before you get a headache of your own.

May your days and pregnancy be headache free!