Headaches in pregnancy: All you need to know

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The presentation or symptoms of the headache depend on the type of headache that you have.

• Tension headaches: If you’re under stress, hungry or feel pain in your neck or shoulders, you could have a tension headache, which feels like a mild to moderate dull ache. It’s one of the most common types.

• Cervicogenic headaches: This refers to a headache arising from dysfunction or inflammation of the musculoskeletal structures of the upper cervical spine.

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• Cluster headaches: These cause a severe “stabbing” pain, typically on one side of the head and around the eye. A person may also notice some other symptoms, such as nasal congestion, watery eyes, or swelling in the area.

• Migraines: With a migraine headache, you can expect moderate to severe pain that throbs and lasts for hours or even days. Some women with migraines also experience blurred vision, light flashes, numbness and nausea.

• Sinus headaches: Pressure around your eyes, cheeks and forehead plus a stuffy nose may signal a sinus headache. These typically occur with a sinus infection, but they’re also commonly confused with migraines. In both cases, the pain can get worse when you bend forward or lie down.

CAUSES FOR HEADACHE

The most common headaches during pregnancy are tension headaches, cervicogenic headaches, cluster headaches, migraines and sinus headache.  (Source: Getty Images)

First trimester

Tension headaches are common in the first trimester of your pregnancy. This may happen because your body is undergoing several changes at this time. These changes may trigger headache pain:

• Hormonal changes

• Higher blood volume

• Weight changes

Common causes of headache pain during the first trimester of pregnancy also include:

• Dehydration

• Nausea and vomiting

• Stress

• Lack of sleep

• Caffeine withdrawal

• Poor nutrition

• Low blood sugar levels

• Too little physical activity

• Sensitivity to light

• Changes in vision

Some foods may also cause headaches. Your trigger foods may change during pregnancy. Common foods that may cause headaches in some people include:

• Dairy

• Chocolate

• Cheese

• Yeast

• Tomatoes

Second and third trimester

Headaches during your second and third trimester may have different causes. These include:

• Extra weight

• Posture

• Too little sleep

• Diet

• Muscle strain and tightness

• High blood pressure

• Diabetes

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Regardless of the type of headache, a common factor is that headaches typically are associated with neck or shoulder tenderness or pain and stress where a physiotherapist can play an important role especially in the cervicogenic headache

Cervicogenic headache (CGH) is a chronic headache that arises from the atlanto-occipital and upper cervical joints and perceived in one or more regions of the head and/or face.

The first purpose is to distinguish a primary headache (when pain is the disease) from a secondary headache (when pain is a symptom of another disease). More strictly, this is the main concern with a pregnant woman suffering from this symptom. Three scenarios are possible:

1. She suffers from a primary headache and now she presents with her usual headache;

2. She does not suffer from a primary headache and she presents with her first severe headache during pregnancy;

3. She suffers from a primary headache, but now pain is different in quality, intensity or associated symptoms.

In the second and third scenarios, headache must be considered as a symptom of an underlying disease until an appropriate diagnostic evaluation has been performed.

The International Headache Society (IHS) has validated Cervicogenic headache as a secondary headache type that is hypothesized to originate due to nociception in the cervical area.

Cervicogenic headaches can mimic migraines, so it may be difficult to distinguish a cervicogenic headache from a migraine headache. The primary difference is that a migraine headache is rooted in the brain, and a cervicogenic headache is rooted in the cervical spine (neck) or base of the skull region.

.Despite the rare cases in which the first attacks occur during the first pregnancy, almost a quarter of pregnant women report that an expected cluster period does not develop during gestation while it may start soon after delivery

Headaches typically are associated with neck or shoulder tenderness or pain and stress where a physiotherapist can play an important role especially in the cervicogenic headache. (Photo: Getty Images/Thinkstock)

SYMPTOMS

In addition to a throbbing head pain, symptoms of a cervicogenic headache may include:

• Pain on one side of your head or face.

• Pain around the eyes.

• A headache with certain neck postures or movement.

• Steady pain that doesn’t throb.

• Head pain when you cough, sneeze, or take a deep breath.

• An attack of pain that can last for hours or days.

• Stiff neck — you can’t move your neck normally.

• Pain that stays in one spot, like the back, front, or side of your head or your eye.

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Cervicogenic headaches can also cause symptoms similar to migraine headaches, such as light sensitivity, noise sensitivity, blurry vision, and an upset stomach.

What can you do to prevent pregnancy headaches?

• Avoid headache triggers. If certain foods or odours have triggered a headache in the past, avoid them. A headache diary might help you identify triggers.

• Include physical activity in your daily routine. Try a daily walk or other moderate aerobic exercise.

• Manage stress. Find healthy ways to cope with stressors.

• Practice relaxation techniques. Try deep breathing, massage and visualization.

• Eat regularly. Eating regularly scheduled meals and maintaining a healthy diet might help prevent headaches. Also, drink plenty of fluids.

• Follow a regular sleep schedule. Sleep deprivation might contribute to headaches during pregnancy.

• Watch your posture. Try not to slouch, slump or bend over while you do close work (knitting tiny booties, crafting your baby’s scrapbook) for long stretches of time.

• Go alternative. To prevent stress from building up into a headache you can consult a physiotherapist.

Physiotherapy management for headache:

Physical therapists cannot alter the chemical imbalances in your body that cause headaches, but they can help reduce other sources of migraines. Physical therapy techniques can strengthen and stretch the neck and back muscles. When these muscles are strained from poor posture or extra weight (as during pregnancy), they can cause headaches and migraine with below mentioned treatment.

• Stretches

• Strengthening exercises

• Re-education of Posture

• Sensorimotor Training

• MFR and trigger point release

• (Myofascial) Mobility, Strength, Stability and Postural Exercises

It’s amazing that most individuals with headaches often comment that receiving physiotherapy treatment acts as a light switch: once treatment is received, the headache switches off.

(The writer is Lead Physiotherapist, Cloudnine Group of Hospitals, Bengaluru – Jayanagar.)

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