Headaches in pregnancy
Two out of three women who suffer from headaches usually stop having headaches during pregnancy, especially in the second and third trimester. Headaches also tend to stop after menopause and at around the same age in men as well. Unfortunately, some women have worsening of their headaches or develop headaches for the first time during their pregnancies. In pregnancy, all attempts are made to avoid medications by using alternative therapies, such as biofeedback, acupuncture, massage, reflexology, application of ice, and aromatherapy. Nausea that often accompanies headaches can be treated with motion sickness bands (Sea-Band, BioBands, Psi-Bands), which are wrist bands with a pressure point placed 2 inches above the wrist crease. This is an acupuncture point and has been proven to relieve nausea induced by motion, pregnancy, chemotherapy, and after surgery. Vitamin B6 (pyridoxine), 30 mg once a day and according to another study, 25 mg three times a day can also stop nausea or pregnancy, and possibly nausea due to headaches. Metoclopramide (Reglan) is prescription medicine which is relatively safe in pregnancy.
For headache pain, acetaminophen (Tylenol) alone or with codeine is usually considered safe for pregnant women. However, codeine often makes headache sufferers nauseous. Aspirin, ibuprofen and naproxen can be used only in the first two trimesters of pregnancy. Triptans (Imitrex and similar drugs), while not approved in pregnancy, are considered safer than allowing a woman to have an uncontrolled migraine attack with nausea, vomiting, and dehydration.
For preventive therapy in pregnancy, magnesium, intravenously or orally should be tried first. Babies born to women who receive an intravenous infusion of magnesium during pregnancy (often also given for premature labor and eclampsia) are less likely to have cerebral palsy and other neurological problems.
Botox injections are not approved in pregnancy, but are considered safer than preventive medications taken daily by mouth. Propranolol (Inderal), a blood pressure medicine which helps prevent headaches, is also not approved for pregnant women, but is considered safe and is often used as the first-line drug. Amitriptyline (Elavil), a tricyclic antidepressant is generally considered safe, although it is also not approved by the FDA for pregnant women. Depakote (divalproex sodium), an epilepsy medicine approved for the prevention of headaches, is strictly contraindicated and should never be used.
Headache which begins soon after delivery requires urgent attention because it can be due to a blood clot in a vein in the brain, which can lead to a stroke. Another possible cause of headaches after delivery is a spinal fluid leak, which can occur as a complication of epidural anesthesia. This headache can easily be treated by a “blood patch” – a relatively simple procedure.
—
Migralex Blog