Extreme headache in pregnancy: what you should know

Pregnancy can bring tension headaches or migraine, while disrupted sleep, missed meals, dehydration, heat, stress, eye strain, and caffeine withdrawal can also trigger head pain. Nasal congestion from allergic rhinitis, a common cold, or chronic sinusitis may cause pressure around the face and forehead. Fever, vomiting, or diarrhoea can worsen dehydration. A headache can also occur with COVID-19 or dengue fever, particularly when fever and body aches are present. These possibilities cannot be distinguished safely from pregnancy-related complications by symptoms alone.

After the middle of pregnancy, a severe or continuing headache can be a warning sign of pre-eclampsia, a condition involving high blood pressure and possible effects on organs. It may occur with visual disturbance, pain under the ribs, sudden swelling of the face or hands, nausea, or feeling unusually unwell.

Stop strenuous activity and rest in a quiet, cool room. Sip water regularly and eat a light meal if you have not eaten. Note when the headache began, where it hurts, how intense it feels, and any associated symptoms. If you can check your blood pressure, record the reading and the time, but do not delay care to obtain a monitor.

Contact your maternity team, obstetrician, or an urgent medical service for advice about an extreme, new, or persistent headache. Do not start painkillers, decongestants, herbal products, or leftover medicines without checking that they are suitable in pregnancy.

Seek emergency care now for a sudden thunderclap headache, the worst headache you have experienced, fainting, seizure, confusion, new weakness or numbness, trouble speaking, or a stiff neck. Get urgent pregnancy assessment for severe headache with blurred or flashing vision, marked swelling, pain beneath the ribs, repeated vomiting, shortness of breath, or a high blood-pressure reading. Fever with a severe headache also needs prompt assessment.

Do not drive yourself if you feel faint, confused, weak, or unable to see clearly. Tell the clinician that you are pregnant, how far along the pregnancy is, and every medicine or supplement you have taken.

Ask: Could my symptoms be related to blood pressure or pre-eclampsia? Should my blood pressure, urine, blood tests, or baby’s wellbeing be checked? Which pain relief is appropriate for me? What symptoms mean I should go directly to emergency care? Could fever, congestion, vomiting, or a recent infection be contributing?