Migraine headaches are a common type of headache in pregnancy. These painful, throbbing headaches are usually felt on 1 side of the head and result from expansion of the blood vessels in the brain. The misery is sometimes accompanied by nausea, vomiting, and sensitivity to light. A small percentage of women with migraines also have an aura with the migraine. They see flashes of light or feel tingling in their arms and legs. Headaches can sometimes be related to blood pressure problems in pregnancy. If they are persistent or severe and happen after 20 weeks of pregnancy, let your health care provider know.
If you think your headaches may be migraines, you'll want to see a doctor to treat them and learn ways to try to avoid getting the headaches in the first place. Sometimes relaxation exercises or changes in diet or sleeping habits are all that's needed. But if needed, a doctor also can prescribe medicine to help control the headaches. You'll also want to see a doctor if you have any of these symptoms as well as a headache:. If you do see a doctor for headaches, he or she will probably want to do an exam and get your medical history to help figure out what might be causing them.
The doctor may also do blood tests or imaging tests, such as a CAT scan or MRI of the brain, to rule out medical problems. Sometimes doctors will refer people with headaches they think might be migraines or a symptom of a more serious problem to a specialist like a neurologist , a doctor who specializes in the brain and nervous system. It's very rare that headaches are a sign of something serious. But see a doctor if you get headaches a lot or have a headache that:. Most headaches will go away if a person rests or sleeps.
When you get a headache, lie down in a cool, dark, quiet room and close your eyes. It may help to put a cool, moist cloth across your forehead or eyes. Breathe easily and deeply. If a headache doesn't go away or it's really bad, you may want to take an over-the-counter pain reliever like acetaminophen or ibuprofen. Migraines typically present with pulsing head pain, nausea, photophobia sensitivity to light and phonophobia sensitivity to sound. Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.
Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache pain arising from the neck muscles. Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches. More serious causes of secondary headaches include: . Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease , non-celiac gluten sensitivity , irritable bowel syndrome , inflammatory bowel disease , gastroparesis , and hepatobiliary disorders.
The brain itself is not sensitive to pain , because it lacks pain receptors. However, several areas of the head and neck do have pain receptors and can thus sense pain. These include the extracranial arteries, middle meningeal artery , large veins, venous sinuses , cranial and spinal nerves, head and neck muscles, the meninges , falx cerebri , parts of the brainstem, eyes, ears, teeth and lining of the mouth. Headaches often result from traction to or irritation of the meninges and blood vessels.
The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated blood vessels , inflammation or infection of meninges and muscular tension can also stimulate nociceptors and cause pain. Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known. There have been different hypotheses over time which attempt to explain what happens in the brain to cause these headaches.
Migraines are currently thought to be caused by dysfunction of the nerves in the brain.
Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted. Currently, most specialists think migraines are due to a primary problem with the nerves in the brain. Triptans, medications which treat migraines, block serotonin receptors and constrict blood vessels.
People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy. Tension headaches are thought to be caused by activation of peripheral nerves in the head and neck muscles . Cluster headaches involve overactivation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown.
Most headaches can be diagnosed by the clinical history alone. Electroencephalography EEG is not useful for headache diagnosis. The first step to diagnosing a headache is to determine if the headache is old or new. It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar. The American College for Emergency Physicians published criteria for low-risk headaches.
They are as follows: .
A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms means that a headache warrants further investigation with neuroimaging and lab tests. In general, people complaining of their "first" or "worst" headache warrant imaging and further workup. Other red flag symptoms include:    . Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches. Migraines are often unilateral, pulsing headaches accompanied by nausea or vomiting.
There may be an aura visual symptoms, numbness or tingling 30—60 minutes before the headache, warning the person of a headache. Migraines may also not have auras. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different. If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache likelihood ratio 3.
Another study found the following factors independently each increase the chance of migraine over tension type headache: nausea, photophobia, phonophobia, exacerbation by physical activity, unilateral, throbbing quality, chocolate as headache trigger, cheese as headache trigger. Cluster headaches are relatively rare 1 in people and are more common in men than women. Temporomandibular jaw pain chronic pain in the jaw joint , and cervicogenic headache headache caused by pain in muscles of the neck are also possible diagnoses.
For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food. While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise. New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or tension-type headaches.
One recommended diagnostic approach is as follows. If the headache is sudden onset thunderclap headache , a computed tomography test to look for a brain bleed subarachnoid hemorrhage should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the CSF, as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal.
If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. If there is jaw claudication and scalp tenderness in an older person, a temporal artery biopsy to look for temporal arteritis should be performed and immediate treatment should be started. The US Headache Consortium has guidelines for neuroimaging of non-acute headaches. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality.
All people who present with red flags indicating a dangerous secondary headache should receive neuroimaging. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging MRI is best for brain tumors and problems in the posterior fossa , or back of the brain. The American College of Radiology recommends the following imaging tests for different specific situations: . A lumbar puncture is a procedure in which cerebral spinal fluid is removed from the spine with a needle.
A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with idiopathic intracranial hypertension usually young, obese women who have increased intracranial pressure , or other causes of increased intracranial pressure. In most cases, a CT scan should be done first. Other classification systems exist. One of the first published attempts was in It contains explicit operational diagnostic criteria for headache disorders.
The first version of the classification, ICHD-1, was published in The current revision, ICHD-2, was published in The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups as secondary headaches, cranial neuralgia , central and primary facial pain and other headaches for the last two groups.
The ICHD-2 classification defines migraines , tension-types headaches, cluster headache and other trigeminal autonomic headache as the main types of primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well. Secondary headaches are classified based on their cause and not on their symptoms.
Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack , non-traumatic intracranial hemorrhage, vascular malformations or arteritis are also defined as secondary headaches. This type of headaches may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm, epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the central nervous system.
ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or by exposure to some substances. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by dialysis , high blood pressure , hypothyroidism , and cephalalgia and even fasting are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including teeth , jaws, or temporomandibular joint.
Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches. The ICHD-2 classification puts cranial neuralgias and other types of neuralgia in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain. Moreover, the ICHD-2 includes a category that contains all the headaches that cannot be classified.
Although the ICHD-2 is the most complete headache classification there is and it includes frequency in the diagnostic criteria of some types of headaches primarily primary headaches , it does not specifically code frequency or severity which are left at the discretion of the examiner.
The NIH classification consists of brief definitions of a limited number of headaches. The NIH system of classification is more succinct and only describes five categories of headaches. In this case, primary headaches are those that do not show organic or structural cause. According to this classification, headaches can only be vascular, myogenic , cervicogenic, traction and inflammatory.
Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit. Migraine can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms. Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling. For example, if the person also has depression, an antidepressant is a good choice.
Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with acetaminophen paracetamol or NSAIDs, like ibuprofen.
Acupuncture is an alternative therapy that may help relieve headaches. From shutterstock. Email an article. Increased intracranial pressure pushes on the eyes from inside the brain and causes papilledema. Medicine that combines aspirin, acetaminophen, and caffeine, such as Excedrin. The American College for Emergency Physicians published criteria for low-risk headaches.
If accompanied by nausea or vomiting, an antiemetic such as metoclopramide Reglan can be given orally or rectally.