Case Study: Julie G.
Julie G is a 26 year old female who is pregnant with her second child. She is now 15 weeks pregnant. She has a history of occasional migraine headaches prior to being pregnant. She now has been having an increase in the number of headaches she's been experiencing. The headaches usually begin about ten o'clock in the morning and stick around most of the day. The headaches are often a throbbing type of pain.
Headache Pain
Unfortunately, women who experience headaches before pregnancy, often notice and increase in the frequency of their headaches the first couple months of pregnancy. Ensuring adequate fluid intake can help decrease their frequency. A small amount of caffeine can also help relieve headaches. Generalize pain in muscles and joints and back can also occur. Some possible options for treating headaches are Tylenol, Tylenol PM (acetaminophen products) and or small amounts of caffeine- such as a cup of coffee.
Migraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy. Certain medicines commonly used to treat headaches should not be used during pregnancy. A woman who has severe headaches should speak to her doctor about ways to relieve symptoms safely.
Julie's Office Visit:
At Julie's 17 week appointment she discusses her frequent headaches with her provider. They reviewed her symptoms as well as any new activities she has been partaking in. She has not changed her diet, and still attends yoga classes three times per week. She says she drinks water throughout the day but forgets when busy with her 2 year old and probably actually drinks only about 3 to 4 glasses of water a day. She still has some nausea throughout the day but is getting better. Often times she doesn't eat regularly because if this nausea. She has not taken any new medications and has been afraid to take any pain medication because she does not want to hurt the baby.
Headaches during pregnancy can be frequent and challenging and are diagnosed in one-third of pregnant women. Most causes are related to pregnancy hormones, water intake, fatigue and blood sugar levels. Less commonly they are related to vascular and infectious disorders. If the clinical features are severe, they must be investigated, and even brain imaging is sometimes required.
Julie's Treatment Plan:
Julie's provider recommended that she begin increasing her fluid intake daily to 64-72 ounces. She could also have a small cup of coffee in the mornings. She was advised to eat more regularly, trying to assure that she gets an adequate amount of protein every couple hours to maintain a good blood sugar. She was reassured that many women can experience increased headaches during the first half of pregnancy and that she may safely use Tylenol (acetaminophen) products as directed, for headache relief if needed. Warning signs and symptoms of concerning headaches were reviewed and Julie was advised to call if the headaches worsen or new symptoms develop.
Particular cautions about treatment must be considered during pregnancy- such as frequent use of pain medications. Non-pharmacological measures, those that are not medicine, are preferred if possible. Relaxation, increased fluids, certain essential oils, and massage can help. Tension-type headaches and cluster headaches seem to be less hormone-dependent and are not as common in pregnancy.
Julie's Followup:
Julie returned for her next OB visit at 21 weeks of pregnancy. She states she has experienced a significant decrease in the frequency of her headaches implementing the strategies discussed at her previous visit. She is using a large water bottle daily that she keeps filled with water. She is eating more regularly as her nausea has almost completely resolved. She has used a couple of Tylenol for her headaches that seem to hang around and this has helped.
Misconceptions:
Many women decide to cut out caffeine completely when they become pregnant. However, a low level of caffeine is considered safe and can help prevent a headache. It is suggested that about a cup to a cup and a half of coffee per day, with a daily maximum of 200 milligrams of caffeine can help reduce a headache.
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