Headaches and migraine attacks are common during pregnancy. Most are nothing to worry about, but some could be indicative of pregnancy complications that could put the mother and fetus at risk. Given that, doctors can have trouble determining whether the headaches are caused by a pre-existing condition, like migraine, or by a pregnancy complication. A new study provides clinical recommendations to help diagnose headache type in pregnant women.

The study found that pregnant women with severe headaches who have higher than normal blood pressure or a lack of a history of headache disorders could be at risk of preeclampsia. These women should be sent for neuroimaging immediately and should be monitored for preeclampsia, according to Matthew S. Robbins, M.D., the study’s lead author.

Preeclampsia (also known as toxemia) usually occurs during the second or third trimester of pregnancy. Symptoms can include headaches, high blood pressure, blurred vision, and abdominal pain. Preeclampsia is thought to be related to an abnormality in the blood vessels that supply blood to the placenta. Treatment ranges from bed rest to premature delivery, depending on the severity of the condition and how far along the pregnancy is.

In the study, the largest of the kind, researchers analyzed the records of every pregnant woman who had a neurological consultation at Weiler Hospital for headaches during a five-year period. Most of the 140 women included in the study had what is known as a primary headache disorder (that is, there headaches were caused by a headache disorder, not another medical condition. Of the 91 women in this category, 90% had migraine. Secondary headache (headaches that are caused by a medical condition unrelated to a headache disorder) was seen in 49 patients; 51% of those were diagnosed with pregnancy-related high blood pressure, including the 38% who had preeclampsia.

High blood pressure proved to be the most obvious symptom of secondary headaches in pregnant women. Women with headache and high blood pressure had a 17-fold increased likelihood of secondary headaches than pregnant women with headache without high blood pressure. In most cases, the high blood pressure and headaches were caused by preeclampsia.

The lack of a previous headache history was another red flag for researchers. It was associated with a five-fold increase in the likelihood the headaches were caused by a condition other than a headache disorder. Other warning signs included fever, seizures, an absence of phonophobia, and psychiatric problems.

REFERENCE

Farmakidis C, Dayal A, Lipton R, Robbins M. Acute Headache Diagnosis in Pregnant Women: A Hospital-Based Study. Neurology. 2015.