Headaches during pregnancy

Most pregnancy headaches are ordinary tension headaches or migraines, driven by hormones, poor sleep, dehydration and caffeine withdrawal. Paracetamol at the lowest effective dose is the usual first choice. A severe headache after 20 weeks with visual changes or swelling needs same-day assessment.

Why pregnancy gives you headaches

Several things arrive together in the first trimester. Oestrogen rises sharply, blood volume increases, and sleep gets worse. Nausea keeps you from drinking and eating on a normal rhythm.

Later on the drivers change. Extra weight pulls on the neck and shoulders, sleep positions get awkward, and by the third trimester most women are tired in a way that feeds straight into tension headaches.

Plenty of women who never had migraines get them now. Plenty of lifelong migraine sufferers find they improve. Both happen.

Which kind of headache is it?

The NHS divides headaches into primary ones, where the headache is the problem, and secondary ones, where it is a symptom of something else. Most pregnancy headaches are primary.

Knowing which one you have changes what you try. A warm shower loosens a tension headache and does nothing for a migraine, while a dark quiet room does the opposite.

What you can safely take

Paracetamol first, at the lowest dose that works, for as short a period as you can manage. That is the standard advice from the NHS and ACOG, and the one your polyclinic or obstetrician will usually give you.

Avoid ibuprofen, diclofenac and other non-steroidal anti-inflammatory drugs unless a doctor has specifically told you otherwise. The US Food and Drug Administration has warned about their use from around 20 weeks of pregnancy, because of effects on the baby's kidneys and the volume of amniotic fluid.

Aspirin is a separate case. Low-dose aspirin is sometimes prescribed in pregnancy for women at risk of pre-eclampsia, which is a different thing entirely from taking it for a headache.

Migraine-specific medicines need a conversation. If you were on a preventer before pregnancy, do not simply stop it; some are continued and some are swapped, and that decision belongs to your doctor.

What helps without medicine

• Water, consistently, rather than a litre when you notice the headache
• A cold pack on the forehead for a migraine, a warm one on the neck for tension
• A dark, quiet, cool room, which is one of the few things that reliably shortens a migraine
• Regular meals, since a long gap drops your blood sugar and starts the ache
• A proper pillow arrangement, because neck position at night does more than most people credit
• A short walk in the evening when it is cooler, rather than a gym session in the afternoon

Shoulder and neck tension responds to gentle massage. Our guide to staying comfortable through pregnancy covers positioning, and prenatal massage covers what is safe and what to tell the therapist.

Heat, kopi and haze

A few local things make pregnancy headaches worse here, and each one is fixable.

Dehydration. You sweat walking from the MRT station to the office, then sit in dry air-conditioning for eight hours. Pregnancy already raises your fluid needs. Most women underestimate how little they drink on a working day, and refilling a bottle at the water cooler is the single easiest intervention on this page.

Caffeine withdrawal. A daily kopi or teh habit is not a small one, and stopping abruptly on the day of a positive test produces a week of headaches. Taper instead. Current advice keeps caffeine moderate rather than banning it, so a kopi C siew dai is usually fine to keep.

Haze. When the PSI climbs, sinus pressure and irritated airways set off headaches in people who never get them. Keep windows shut, use a purifier if you have one, and take the covered route.

Air-conditioning deserves its own note. Sleeping under a cold draught stiffens neck muscles, which is a classic tension headache the next morning. Point the vent away from the bed.

The headache that needs a doctor today

• Severe headache after 20 weeks, especially with blurred vision or flashing lights
• Swelling of the face, hands or feet, or sudden weight gain
• Pain under the ribs on the right, or vomiting with the headache
• The worst headache of your life, or one that comes on in seconds
• Fever, a stiff neck, confusion, or weakness down one side
• A headache that wakes you from sleep every night, or one that does not shift over days

The reason this list is long is pre-eclampsia. The American College of Obstetricians and Gynecologists lists a severe headache with visual changes as a warning sign, and it is why your blood pressure and urine get checked at every antenatal visit.

Where to go in Singapore depends on the hour. In office hours, your polyclinic or the antenatal clinic where you are booked. Out of hours, the obstetric urgent service at KK Women's and Children's Hospital or the National University Hospital, or the nearest emergency department if symptoms are severe. Nobody there will think you overreacted.

Keep a two-line diary

Write down the day, the time it started, how long it lasted, and what you had eaten, drunk and slept. Four lines a week is enough.

Patterns show up fast. Mothers who do this often find the trigger is a skipped lunch, a late night, or the afternoon when they switched from two kopi to none. That is a cheap thing to learn, and it makes the next antenatal appointment far more productive than saying you get headaches sometimes.

For the wider picture, our list of things to avoid during pregnancy covers caffeine and heat, and improving your pregnancy mood deals with the sleep and stress side of the same problem.