What should you know about a real bad headache during pregnancy?

Headache can be linked with dehydration, missed meals, poor sleep, stress, migraine, congestion, or an infection such as a cold. However, a new or unusually severe headache in pregnancy can be associated with high blood pressure and pregnancy complications. Pay attention to timing, location, severity, and associated symptoms. A headache with fever may occur with COVID-19 or dengue fever, but symptoms overlap and cannot confirm a cause by themselves. Sinus pressure, a blocked nose, or facial pain may point toward allergic rhinitis or sinusitis.

Stop strenuous activity, rest in a quiet space, and drink fluids if you can keep them down. Eat a small meal if you have missed food. Do not start, stop, or combine medicines without checking with your maternity team or clinician, because pregnancy changes which treatments are suitable. Note when the pain began, where it is, what it feels like, and whether you have swelling, visual symptoms, fever, vomiting, or reduced movement later in pregnancy. Contact your maternity service or GP promptly for a new, severe, or persistent headache.

Seek urgent maternity or emergency assessment for a sudden severe headache, visual changes, confusion, fainting, weakness, trouble speaking, chest pain, shortness of breath, severe upper abdominal pain, marked swelling, fever with a stiff neck, repeated vomiting, or reduced fetal movement. Do not wait for the headache to settle when these symptoms occur.

Could my blood pressure or urine need checking? Which pain relief is suitable for me? Do my symptoms suggest migraine, infection, or a pregnancy complication? When should I return or call the maternity unit?