4 Causes of Headache in a 39-Week Pregnant

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1. Tension-type headache (TTH).

Tension-type headache is the most widespread type of headache. It is a mild to moderate headache (often felt as a tight band around the head.

The exact cause of TTH is not known. However, TTH got its name from the belief that it results from the tension (spasm) of the head muscles.

More than 90% of the headaches are tension-type headaches.

TTH may partially improve during pregnancy, but it doesn’t go away. Because it is the most widespread type of headache, TTH may be the most likely cause of headache in 39 weeks pregnant females

we divide TTH into three main subcategories according to headache frequency:

1. Episodic, infrequent TTH: Episodes less than one day a month
2. Episodic, Frequent TTH: Episodes from one to 14 days a month.
3. Chronic TTH: Episodes 15 or more days a month.

Symptoms:

• Unlike migraine and cluster headaches, The characteristics of TTH are generally non-specific (Called the featureless headache).
• Location: Often bilateral and diffuse in nature (surround the head or neck as a cap.
• Severity: Mild to moderate (often not severe as migraine and cluster headache.
• Character: Dull constant ache in the head (not throbbing or pulsating).
• Duration of the single attack: It is highly variable, but it is often at a lead of 30 minutes duration and may last for several days (in a single episode).
• Frequency of attacks: described above for the different subtypes of TTH (episodic frequent, episodic infrequent, and chronic types).
• Associated symptoms such as nausea, vomiting, intolerance to light, or sounds are absent or very minimal.
• Tenderness over the head or neck muscles at the headache location is common.

2. Anemia.

According to the WHO, anemia affects about 40% of pregnant females (reference). Pregnant females are more likely to have anemia because of the increased nutritional demands.

The major causes of anemia during pregnancy include:

• Iron deficiency anemia (in more than 95%).
• Folic acid deficiency anemia.
• Vitamin B-12 deficiency anemia.

Symptoms of anemia in the last trimester include:

• Easy fatigue on minimal exertion.
• Feeling weak.
• Shortness of breath (especially during effort).
• Palpitations (sensation of rapid heartbeats.
• Dizziness or lightheadedness.
• Chest pain on exertion.
• Pale or yellowish skin and lips.
• Headaches and loss of concentration.
• The symptoms such as headaches and shortness of breath progress over time. If untreated, anemia-induced headaches become more prominent in the last weeks (39 and 40th weeks of pregnancy).

Treatment:

The most common type of anemia is often iron deficiency anemia due to the increased demands of the pregnant female.

According to the severity of your anemia, iron supplementation typically improves the condition. Oral and intravenous formulations are available according to the severity (intravenous iron is reserved for severe cases)

In a 39-week pregnant woman, iron may not be suitable as there is not enough time to work. Your doctor may decide to prescribe blood transfusion according to the severity of anemia.

3. Pre-eclampsia.

Sudden onset of headache and lower limb edema in a 39-week pregnant woman should raise the suspicion of preeclampsia.

Preeclampsia is a severe pregnancy complication leading to high blood pressure edema in the lower limbs.

The exact cause of preeclampsia is still not well-understood. Fortunately, preeclampsia resolves with delivery.

Call your doctor immediately if you think your headache is due to preeclampsia. The disease may require urgent delivery to treat the condition.

Symptoms:

• Sometimes, preeclampsia develops without any symptoms or just with a mild headache.
• So, measuring the blood pressure is very important in a 39-week pregnant with a headache even if the blood pressure was normal before.
• Excess protein in urine manifesting as pale-colored urine with extra froth on the toilet.
• Swelling of the lower limbs (lower limb edema).
• Swelling of the face and eyes.
• Sudden weight gain.
• Headaches (range from mild to severe).
• Blurred vision.
• Other visual symptoms include intolerance to bright lights or temporary vision loss.
• Decreased urine output.
• Nausea or vomiting.
• Shortness of breath.

4. Migraine.

 

Migraine headache is another common type of chronic headache with more severe symptoms. Migraine affects about 15% of people worldwide (reference).

Migraine is usually a severe type of headache felt as throbbing or pulsation pain on one side of the head (30% felt bilateral).

The cause of migraine headaches is also not well understood. However, it is thought to be related to temporary changes inside your brain (brain chemicals, nerve cells, or blood vessels).

During pregnancy. Migraine headaches tend to improve. However, They remain a significant cause of primary headaches in pregnant females in the last weeks of pregnancy (39 and 40 weeks).

Symptoms:

Migraine has more distinctive features that separate it from tension-type headaches. Migraine tends to be more severe, unilateral, pulsating, and associated with an aura (see below).

The typical migraine attack passes into four stages:

1. Migraine prodrome:

• Occurs in most patients (77% of patients with migraine pass through the prodrome stage).
• Prodrome symptoms are a group of affective or mood symptoms that proceeds with the headache.
• Common symptoms include repeated yawning, euphoria, depression, irritability, food cravings, neck stiffness, and sometimes constipation.

2. Migraine Aura:

• Affects about 25% of patients with migraine.
• They are a group of neurological symptoms and are characteristic of migraine; they include:
• Visual symptoms (bright lines, shapes, objects, or visual loss).
• Hearing symptoms (tinnitus, hearing noises, music, or loss of hearing).
• Abnormal movements or inability to move a part of your body.
• Patients can experience one or more symptoms at the same time.
• Duration: the symptoms develop gradually but disappear rapidly in no longer than an hour.

3. The migraine headache stage.

• Starts after or during the aura stage.
• It is often unilateral (70%), but it can be bilateral (30%).
• Pulsation or throbbing in character is felt in the front and sides of the head.
• The duration of the attack is at least 4 hours, and it can last for several days if left untreated.
• Headache is often exacerbated by daily activities such as walking or climbing stairs (impairing the quality of life).
• It can be associated with other symptoms such as nausea and vomiting.

4. Migraine postdrome.

• Starts after the resolution of the headache.
• The patient may feel pain when he turns his head or neck.
• Exhaustion and fatigue.

5. Others.

• Cluster headaches.
• Sinus headaches.
• Lack of sleep.
• Fever due to common conditions such as common cold and influenza.
• Neck spine problems.
• Trauma to the head.
• And others.

When To see a doctor?

The following condition may require seeing a doctor:

• Severe headache
• Problems with vision, such as blurring or seeing flashing lights
• Pain just below your ribs
• Vomiting
• A sudden increase in swelling of your face, hands, feet, or ankles.

• Evidence-based
• Written by a doctor.

MD, Internal Medicine and Nephrology specialist.

Dr. Esraa A. MagidAuthor

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