Oh, my head is bursting!

“I love being pregnant. I like it more than not being pregnant. But the headaches, my God the headaches,” wrote model and author Chrissy Teigen’s on social media. “Someone... please help. Don’t say water. Or Tylenol. Or iron. Or magnesium. I need witchcraft,” the heart-wrenching post went on.

Most women experience headaches during pregnancy and during the postpartum period. Most of them manage the condition themselves or with primary care. But those headaches that are not relieved by general measures and simple pain killers have to be evaluated and managed. Headaches during the postpartum phase have to be addressed very seriously, experts warn.

Along with all the joys of having a baby, the postpartum period can bring discomforts. Migraine headaches in women are closely linked to hormonal changes. The postpartum (after delivery) period is one in which many such changes are experienced. A headache in the first six weeks after childbirth is called a postpartum headache, says Dr Bhavana Kasu, Obstetrician and Gynaecologist, Birth Right by Rainbow Hospitals.  

Understanding postpartum headaches

Hormonal changes, dehydration, anaesthesia, and sleep irregularity can all contribute to headaches after delivery. According to the Society for Obstetric Anaesthesia and Perinatology (SOAP), headaches can be so severe that they compromise the ability of the mother to care for her child; it can prolong hospital stay, and can increase the overall cost of healthcare. The most common cause of a headache in the postpartum period is an exacerbation of primary headache syndromes, such as migraine, cluster, and tension headaches, says Dr Kasu.

SYMPTOMS

* Headaches that occur within 6 weeks of delivery.

TYPES

Primary headaches can be:

* Tension headaches
* Migraine attacks

Secondary headaches can be due to some underlying conditions such as:

* Hypertension/pre-eclampsia
* Drug-related issues like BP correction medication, nifedepine
* Post-dural tap due to epidural analgesic
* Brain haemorrhage
* Infection — Meningitis
* Cerebral venous thrombosis
* Caffeine withdrawal

Headaches due to complications following administration of epidurals:

Talking about the post-dural puncture headache, Dr Kasu says, “It happens with epidurals (pain relief injections given in the space around the spinal cord) and if there is accidental puncture of brain mater with the epidural needle, 70 per cent to 80 per cent of patients develop headaches.”

Post-dural puncture headache (PDPH), also known as post lumbar puncture (LP) headache, is often accompanied by neck stiffness, photophobia, nausea, or subjective hearing symptoms. “The headache is usually in the front and back regions of the head and neck. It typically develops 24-48 hours post puncture, and worsens on standing,” she adds. Post-dural puncture headache due to epidurals can be treated with oral liquids and pain killers. “The patient might recover in seven to 10 days,” according to Dr Kasu.

“Post-delivery, if they complain of limb weakness and a neurological examination shows up abnormalities, it may be central venous thrombosis, a serious problem. If the headache changes with posture, it could be due to change in CSF fluid pressure. A headache awakening the patient can be migraine,” she explains. So if a woman who has recently delivered a baby complains of a headache, don’t take it lightly. Monitor her condition and consult the doctor if the pain continues or gets worse.