Headache in pregnancy: a brief practical guide

Katherine Phillips; Jessica Davison; Benjamin Wakerley

doi:10.3399/bjgp22X721457

Headaches are a common neurological presentation during pregnancy. Though the majority of headaches pregnant women experience (for example, migraine and tension-type headache) can be managed in primary care, some headaches, especially when associated with other neurological or visual symptoms, require urgent investigation to exclude more sinister causes. This article provides a practical guide to headache management with a focus on when to refer to secondary care and what medication is safe during pregnancy and breastfeeding.

SECONDARY HEADACHES: RED FLAGS AND WHEN TO REFER

Pregnancy is an independent risk factor for secondary headaches due to unique physiological changes that occur, such as hypercoagulability.¹ This can be further exacerbated by nausea, vomiting, and dehydration, particularly in the first trimester. Therefore, preferably, all pregnant women with new-onset or worsening headache should be reviewed face-to-face. This allows for neurological examination, a blood pressure reading, and fundoscopy. Urine should always be dipped for protein. Patients who look systemically unwell or display new focal neurological deficits in the context of new headache should be referred for urgent assessment to secondary care.

Fundoscopic examination and identification of papilloedema, either in the GP surgery or by the optician, is mandatory if …

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