From the Guidelines
Headaches are reduced during pregnancy for some women primarily due to hormonal changes, specifically the stabilization of estrogen levels and the increased production of natural pain-relieving endorphins. These hormonal changes can lead to a decrease in the frequency and intensity of headaches, particularly migraines, as noted in the context of managing migraine in pregnancy 1. Some key factors contributing to this reduction include:
- The rise in estrogen levels, which can stabilize previously fluctuating hormone levels that often trigger headaches
- The production of higher levels of natural pain-relieving endorphins, which may help reduce headache frequency and intensity
- Improved circulation due to the increase in blood volume by about 50% during pregnancy
- Lifestyle modifications, such as reducing caffeine intake, improving sleep habits, and avoiding certain headache triggers, which can lead to fewer stress-related headaches It's essential to note that while some women experience a reduction in headaches during pregnancy, others may actually experience worsening headaches, particularly in the first trimester when hormone levels are changing rapidly 1. If headaches during pregnancy are severe or accompanied by other symptoms like visual changes or swelling, medical attention should be sought immediately as they could indicate serious conditions like preeclampsia. In managing migraines during pregnancy, it's crucial to consider the potential harm to the fetus from various medications, and thus, treatments like paracetamol are preferred for acute migraine treatment, with options like propranolol considered for preventive therapy under specialist supervision 1.
From the Research
Reduction in Headaches during Pregnancy
- Some women experience a reduction in headaches during pregnancy, with studies suggesting that this occurs in 55 to 90% of pregnant women, particularly those with menstrual migraine 2.
- The improvement in migraine symptoms during pregnancy is thought to be related to the uniformly high and stable estrogen levels during this period, which can have a beneficial effect on migraine 2, 3.
- A longitudinal prospective study found that headache activity improved significantly for 41% of women during pregnancy, with a slightly greater tendency for improvement in women with migraine compared to those with tension-type or combined migraine and tension-type headaches 3.
Hormonal Changes and Headache
- Hormonal changes throughout the lifecycle, particularly the fluctuations in estrogen levels, can influence the occurrence and severity of headaches in women 2, 4.
- Rising estrogen levels during pregnancy can lead to an improvement in headache symptoms, while falling levels postpartum can cause a worsening of symptoms 3, 4.
Secondary Causes of Headache during Pregnancy
- While some women experience a reduction in headaches during pregnancy, others may develop secondary causes of headache, which can be life-threatening 5, 6.
- Secondary causes of headache during pregnancy can include homeostatic disturbances, hypertensive disorders, vascular problems, space-occupying lesions, and infections 5, 6.
- It is essential to recognize and treat secondary headache disorders promptly to avoid endangering the life of the mother and the fetus 6.