I know a headache can be a symptom of preeclampsia. How can I tell the difference between a normal headache or migraine and the preeclampsia headache?It can be tricky to diagnose preeclampsia because many of the symptoms could be preeclampsia but could also be other things, including being totally normal. Headaches are very common in pregnancy. You have shifting hormones, increased blood supply, and lots of changes going on in your body. You may not be sleeping well. If you have morning sickness (or worse, hyperemesis), you may not be eating and hydrating well. As your shape and weight shift around and you carry yourself differently, you have new strain on your back and neck muscles. You can be more prone to sinus headaches/infections during pregnancy as well. What is normal?
Even women who rarely get headaches can start getting them in pregnancy. Most of the time, these headaches are normal and harmless. Annoying, yes, but harmless. And they have nothing to do with preeclampsia. They are not early signs or red flags, they are just a normal part of pregnancy. If you are getting frequent headaches, you can ask your doctor about treatments.
Home treatment options include:
pregnancy approved pain medication
hydration (including something with electrolytes)
hot compresses to the neck/back for muscle tightness
cold compresses to the forehead or neck
if your headache is sinus related, ask your doctor what medications are approved for pregnancy, or try humidifier/vaporizer, hot compress to the forehead, NetiPot, eating something spicy.
if home treatments aren't enough, ask about prescription options.
What is concerning?
There is a very specific type of headache that is related to preeclampsia. It is caused by brain swelling. When the placenta starts struggling, it releases a chemical called sFlt1. This prevents the regular wear and tear on our cardiovascular system from being repaired. Small holes start to open up in our blood vessels. When these holes happen in our brains, fluid can leak in and cause cerebral edema. This is an end stage symptom right before seizures and death, and it requires delivery soon after appearing. They will treat you with magnesium sulfate to prevent seizures. Depending on your gestation, they may try to hold off long enough to get two doses of steroids, or they may just go ahead with induction or C-section.
Most women experiencing cerebral edema report a severe headache, the worst headache of their lives. It does not respond to usual home treatments, not even to take the edge off. If you have tried the treatments mentioned above and the pain improves, even if it doesn’t go away completely, it is probably NOT the preeclampsia headache. If you have tried all of the above and the headache is still just as severe or worse, you need to go in and get checked. If it turns out to be brain swelling, you should be prepared to deliver. If it is not, if it is just a really bad, persistent, regular migraine or headache, they can try stronger pain medication to try to get you relief.Other symptoms of brain swelling include visual disturbances (though these can also happen with migraine headache), hyper reflexes, and clonus. When you go in for evaluation, they should tap your knee and push your foot back against your ankle as one way to confirm or rule out brain swelling.
Post partum headachesHeadaches can happen post partum for a number of the same reasons as during pregnancy--hormone shifts, lack of sleep, dehydration. It is also possible for preeclampsia to worsen or strike for the first time post partum. As described above, if you have tried usual treatments but your headache is not helped, let your doctor know so you can be evaluated. You may need treatment with magnesium sulfate to prevent post partum eclamptic seizures. There is one other type of headache that is specific to post partum. With spinal or epidural anesthesia, it is possible for spinal fluid to leak from the puncture if it does not seal properly. This can lead to a severe headache. One way to test for this is to lie completely flat on your back and see if your headache improves. If it does, let your doctor know. They may have you spend some time lying flat in hopes that the puncture will finally seal itself. In some cases, you may need to come in for a blood patch. They draw some of your blood and inject it into the space around the puncture to help it close.
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