Headaches during pregnancy

Experts don't know exactly why carrying a child tends to make your head ache more often, but one good guess is the hormonal free-for-all that's taking place in your body. Going cold turkey on caffeine can also make your head pound. Other potential culprits include lack of sleep or general fatigue, sinus congestion, allergies, eyestrain, stress, depression, hunger, and dehydration.

For most women, pregnancy headaches tend to diminish or even disappear during the second trimester, when the flood of hormones stabilizes and the body grows accustomed to its altered chemistry.

What about migraines?

Migraine headaches occur when the blood vessels in your brain constrict and then dilate. Most people describe a migraine as a severe throbbing pain on one side of the head, often accompanied by nausea and vomiting. Experts estimate that about one in five women has a migraine headache at some time in her life, and about 15 percent of migraine sufferers get migraines for the first time when they're pregnant (most often in the first trimester).

Fortunately, about two-thirds of women who are prone to migraines notice that they improve during pregnancy. (This is more likely if your migraines tended to be worse around your periods or started when you first began menstruating.) Others notice no change, or find that their headaches become more frequent and intense. But even if you're part of the unlucky minority whose migraines don't improve during pregnancy, you can at least take some solace in the fact that migraine sufferers (and their babies) are at no higher risk than other women for pregnancy complications.

What kind of pain medication can I take?

Acetaminophen is safe to take as directed on the label, but most other headache medications - such as aspirin and ibuprofen, as well as most prescription migraine drugs - are not recommended for pregnant women. Consult your practitioner about which ones you can take if you're prone to severe migraines. If you're having frequent, debilitating headaches, the benefits of certain medications may outweigh any possible risks to your baby, although other drugs will remain strictly off-limits.

What else can I do to relieve the pain?

Here are a few more suggestions to help you ward off headaches or get relief once you have one:

Figure out what's triggering the pain

Headache docs often recommend keeping a "headache diary" to help identify specific triggers. Write down anything you've eaten in the 24 hours preceding the onset of a migraine and what you were doing when it started. Some common migraine triggers include foods that contain monosodium glutamate (MSG), nitrites (common in processed meats like hot dogs, salami, and bacon), sulfites (used as a preservative for salads and also found in many dried fruits), artificial sweeteners, certain beans and nuts, aged cheese and cultured dairy products (like buttermilk and sour cream), certain fresh fruits (bananas, papayas, avocados, and citrus), smoked fish, chocolate and carob, things that are fermented or pickled (like soy sauce or sauerkraut), glaring or flickering lights, loud noises, excessive heat or cold, strong odors, and tobacco smoke.

Use compresses

For tension headaches, apply a warm or cool compress to your forehead or the base of your neck. Cold compresses tend to work best for migraines.

Take a shower

A simple but effective remedy for some migraines, a cold shower works by constricting the dilated blood vessels, often bringing fast, if brief, relief. If you can't take a shower, splash some cool water on your face. A warm shower or bath can be soothing for tension headaches.

Get a massage

If you have the time and money, by all means get a full-body massage from a trained therapist. But if that's only a pipe dream, ask your partner to rub your back and head, or slip into a salon for a professional shampoo. Massage works especially well on headaches caused by tension that builds in the neck, shoulder, and back muscles.

Don't go hungry or thirsty

To prevent low blood sugar - a common headache culprit - eat smaller, more frequent meals. If you're on the go, keep some snacks (crackers, fruit, yogurt) within reach. Avoid straight sugar, like candy, which can cause your blood sugar to spike and crash. And don't forget to drink plenty of water to stay well hydrated as well. Sip water slowly if you have a migraine and have vomited.

Avoid fatigue

Try to make room for naps in your day. If you're having a migraine, try to sleep it off in a quiet, dark room.

Get some exercise

Some evidence shows that regular exercise can reduce the frequency and severity of migraines and reduce the stress that can cause tension headaches. But get started slowly, since a sudden burst of activity could trigger a migraine.

Try relaxation techniques

Meditation, yoga, and biofeedback are helpful in reducing stress and headaches in some sufferers.

Consider acupuncture

Needle acupuncture treatment is considered safe during pregnancy and may be effective for headaches, according to the National Institutes of Health. Ask your healthcare provider for the names of acupuncturists and keep her posted on your treatments.

Can a headache be a sign of something more serious?

In some cases, yes. Though most headaches during pregnancy are unpleasant but harmless, they can be a sign of a more serious problem. If you're having a migraine for the first time ever, you'll need a full medical evaluation to be sure nothing else is going on. And, in the second or third trimester of pregnancy, a headache could be a sign of severe preeclampsia, a serious pregnancy-induced syndrome that includes high blood pressure, protein in the urine, and other changes.

When should I call my healthcare provider?

Call your provider right away if:

• You're in your second or third trimester and have a bad headache or a headache for the first time (which may or may not be accompanied by visual changes, sharp upper abdominal pain, sudden weight gain, or swelling in your hands or face). You'll need your blood pressure and urine checked right away to be sure you don't have preeclampsia. (If you've been having any problems with high or rising blood pressure, call even if you have a mild headache.)

• You have a sudden "explosive" headache, violent pain that awakens you from sleep, a headache that doesn't go away, or one that feels unlike any you've ever experienced before.

• Your headache is accompanied by a fever and a stiff neck.

• Your headache is getting worse, and you experience any other problems such as blurry vision or other visual disturbances, slurred speech, drowsiness, numbness, or a change in normal sensation or alertness.

• You have a headache after falling and hitting your head (or after any other kind of head injury).

• You have nasal congestion, and pain and pressure underneath your eyes or other facial or even dental pain. You might have a sinus infection that will need to be treated with antibiotics.

Even if you've had headaches before, talk about your pregnancy headaches with your healthcare provider so she can decide what kind of evaluation and treatment might be best for you during your pregnancy. If you're a migraine sufferer, you won't be able to take most of the medications you've taken before - ask your caregiver before taking any medication other than acetaminophen. Also, if you feel like your eyes are straining and notice that you get headaches after reading or looking at a computer screen, have your vision checked by an eye doctor. Finally, don't hesitate to call whenever a headache just has you worried.